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Eur J Pediatr Surg 2023; 33(02): 144-151
DOI: 10.1055/s-0042-1742302
Original Article

Factors Influencing Performance in Laparoscopic Suturing and Knot Tying: A Cohort Study

Lina Armbrust‡   *
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
,
Moritz Lenz‡   *
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
,
Julia Elrod
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
2   Department of Pediatric Surgery, University Medical Center Mannheim, Germany
,
Antonia Kiwit
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
,
Konrad Reinshagen
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
,
Johannes Boettcher 
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
3   Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
,
Michael Boettcher
1   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Germany
3   Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
› Author Affiliations Funding None.
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Abstract

Background Laparoscopic suturing and knot tying are regarded as some of the most difficult laparoscopic skills to learn. Training is essential to reach proficiency, but available training opportunities are limited. Various techniques to improve training have been evaluated. It appears that individual-related factors affect initial performance and response to training. Thus, the current study aimed to assess factors influencing laparoscopic-suturing and knot-tying performances.

Methods All patients were trained one-on-one (teacher–student) for 3 hours. Patients were tested before training (bowel anastomosis model) and directly after training (congenital diaphragmatic hernia or esophageal atresia model) to evaluate transferability. Primary endpoints were time, knot quality, precision, knot strength, and overall laparoscopic knotting performance. Moreover, factors such as (1) age, (2) gender, (3) handedness, (4) previous training or operative experience, (5) playing an instrument, (6) sportive activities, and (7) computer gaming which may influence the primary endpoints were assessed.

Results In total, 172 medical students or novice surgical residents were included. Training significantly improved all outcome parameters assessed in the current study. More than 50% of the patients reached proficiency after 3 hours of training. Personal factors like operative experience, playing music instruments, sportive activities, and computer gaming affected some outcome parameters. Handedness and gender affected initial performance but differences partially subsided after training. Younger participants showed a much better response to training.

Conclusion In conclusion, several factors influence initial performance and response to the training of laparoscopic suturing and knot tying. Surgeons who want to improve their laparoscopic performance, should concentrate on playing a musical instrument and performing sports rather than playing videos gaming. It appears that training is a key and more practice opportunities should be incorporated into medical school and surgical curricula. Moreover, handedness may affect the outcome but only if the training concepts are not tailored to the dominant hand of the surgeon. Future training and surgical curricula should adapt to this and tailor their concepts accordingly.

Keywords

spaced learning - laparoscopy - suturing - surgery - training - halsted - peyton

Authors' Contrubutions

L.A. acquired the data, validated statistics, drafted the initial manuscript, and approved the final manuscript as submitted. M.L. acquired the data, drafted the initial manuscript, and pproved the final manuscript as submitted. J.E. acquired the data, acted as course instructor, and approved the final manuscript as submitted. A.K. acquired the data, and approved the final manuscript as submitted. K.R. conceptualized and designed the study and approved the final manuscript as submitted. J.B. acquired the data, conceptualized the questionnaire, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted. M.B. conceptualized and designed the study, acquired the data, performed statistics, drafted the initial manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Ethical Approval

The Medical Ethics committee of the Medical Association of Hamburg (Ethik-Kommission der Ärztekammer Hamburg) declared that no formal ethical approval was needed for this study.


* These authors contributed equally and retain the first authorship.




Publication History

Received: 03 August 2021

Accepted: 21 December 2021

Article published online:
14 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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