Sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying-a randomized controlled trial "The Shoebox Study" DRKS00008668.

PURPOSE: Learning curves for minimally invasive surgery are prolonged since psychomotor skills and visuospatial orientation differ from open surgery and must be learned. This study explored potential advantages of sequential learning of psychomotor and visuospatial skills for laparoscopic suturing and knot tying compared to simultaneous learning.

METHODS: Laparoscopy-naïve medical students were randomized into a sequential learning group (SEQ) or a simultaneous learning group (SIM). SEQ (n = 28) trained on a shoebox with direct 3D view before proceeding on a box trainer with 2D laparoscopic view. SIM (n = 25) trained solely on a box trainer with 2D laparoscopic view. Training time and number of attempts needed were recorded until a clearly defined proficiency level was reached.

RESULTS: Groups were not different in total training time (SEQ 5868.7 ± 2857.2 s; SIM 5647.1 ± 2244.8 s; p = 0.754) and number of attempts to achieve proficiency in their training (SEQ 44.0 ± 17.7; SIM 36.8 ± 15.6; p = 0.123). SEQ needed less training time on the box trainer with 2D laparoscopic view than did SIM (SEQ 4170.9 ± 2350.8 s; SIM 5647.1 ± 2244.8 s; p = 0.024), while the number of attempts here was not different (SEQ 29.9 ± 14.1; SIM 36.8 ± 15.6; p = 0.097). SEQ was faster in the first attempts on the shoebox (281.9 ± 113.1 s) and box trainer (270.4 ± 133.1 s) compared to the first attempt of SIM on the box trainer (579.4 ± 323.8 s) (p < 0.001).

CONCLUSION: In the present study, SEQ was faster than SIM at the beginning of the learning curve. SEQ did not reduce the total training time needed to reach an ambitious proficiency level. However, SEQ needed less training on the box trainer; thus, laparoscopic experience can be gained to a certain extent with a simple shoebox.