Assessment of Laparoscopic Suturing Skills of Urology Residents: A Pan-European Study

Background: It has been acknowledged that standardised training programmes are needed to improve laparoscopic training of urologic trainees. Previous studies have suggested that simulator-based laparoscopic training can improve performance during real laparoscopic procedures. Objective: To determine if there are performance differences for the completion of a simulated laparoscopic suturing task among urology residents based on their postgraduate year of training (PGY). Design, setting, and participants: Using a validated scoring checklist, two independent observers objectively scored the completion of a standardised laparoscopic suturing task in a bench-top laparoscopic box trainer. PGY and previous exposure to laparoscopic surgery and laparoscopic simulated training was obtained from self-administered questionnaires. Data acquisition was undertaken at the European Urological Residents Education Programme (EUREP) 2007, run by the European School of Urology, and included a pan-European cohort of 201 urology residents. Measurements: Reliability among those rating the suturing tasks was excellent (Cronbach's alpha = 0.83). Each resident was scored for the suturing task. Residents were categorised into three groups based on their PGY status (junior [n = 8]; intermediate [n = 37]; senior [ n = 156]). The Kruskal-Wallis test was used to measure trend across the PGY; the Mann-Whitney U test was used to determine variation among categorised PGY groups. Results and limitations: Laparoscopic suturing skill was significantly different across PGY levels (p = 0.032), and between junior residents and both intermediate and senior residents (p = 0.008 and p = 0.012, respectively). There was no significant difference between intermediate and senior residents (p = 0.697). Only 12% of participants rated their existing volume of laparoscopic operative cases as sufficient, while 55% of participants had no regular opportunities, and 32% of participants had not performed laparoscopic procedures as primary surgeon. Most residents (96%) reported the use of laparoscopic simulators to be beneficial in training, although current European training programmes appear to provide <50% of residents with the opportunity to train with them. Conclusions: A discernable relationship existed between the score obtained for a laparoscopic suturing task and year of resident training. Modular simulator training as part of a formal training programme may help to overcome some of the shortfall in residents' exposure to laparoscopic procedures as primary surgeon. (C) 2008 European Association of Urology. Published by Elsevier B. V. All rights reserved.