Prospective, Randomized, Double-Blind Trial of Curriculum-Based Training for Intracorporeal Suturing and Knot Tying

Kent R. Van Sickle, E. Matt Ritter, Mercedeh Baghai, Adam E. Goldenberg, Ih Ping Huang, Anthony G. Gallagher, C. Daniel Smith

Research output: Contribution to journalArticlepeer-review

132 Scopus citations


Background: Advanced surgical skills such as laparoscopic suturing are difficult to learn in an operating room environment. The use of simulation within a defined skills-training curriculum is attractive for instructor, trainee, and patient. This study examined the impact of a curriculum-based approach to laparoscopic suturing and knot tying. Study Design: Senior surgery residents in a university-based general surgery residency program were prospectively enrolled and randomized to receive either a simulation-based laparoscopic suturing curriculum (TR group, n = 11) or standard clinical training (NR group, n = 11). During a laparoscopic Nissen fundoplication, placement of two consecutive intracorporeally knotted sutures was video recorded for analysis. Operative performance was assessed by two reviewers blinded to subject training status using a validated, error-based system to an interrater agreement of ≥ 80%. Performance measures assessed were time, errors, and needle manipulations, and comparisons between groups were made using an unpaired t-test. Results: Compared with NR subjects, TR subjects performed significantly faster (total time, 526 ± 189 seconds versus 790 ± 171 seconds; p < 0.004), made significantly fewer errors (total errors, 25.6 ± 9.3 versus 37.1 ± 10.2; p < 0.01), and had 35% fewer excess needle manipulations (18.5 ± 10.5 versus 27.3 ± 8.6; p < 0.05). Conclusions: Subjects who receive simulation-based training demonstrate superior intraoperative performance of a highly complex surgical skill. Integration of such skills training should become standard in a surgical residency's skills curriculum.

Original languageEnglish (US)
Pages (from-to)560-568
Number of pages9
JournalJournal of the American College of Surgeons
Issue number4
StatePublished - Oct 2008

ASJC Scopus subject areas

  • General Medicine


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