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Background: Laparoscopic models are increasingly recognized as important tools in surgical training. The purpose of this study was to compare pediatric and adult laparoscopic surgical skills, and gain insight into the upskilling in both groups., Materials and Methods: Adult- and pediatric-sized laparoscopic simulators were fitted with custom-built motion tracking hardware and software. Participants were recruited at the Education Booth of the 2012 combined SAGES/IPEG meeting. They each performed 1 adult and 1 pediatric intracorporeal suturing task. Velocity, acceleration, and range were studied in all degrees of freedom available during laparoscopic surgery (pitch, yaw, roll, and surge). Participants were stratified by expertise based on the traditional metrics of self-reported caseloads., Results: A total of 57 participants (15 novices, 7 intermediates, and 35 experts) were recruited. Experts had significantly higher extreme events in three of the four degrees of freedom when using the pediatric simulator than when using the adult simulator. Few significant differences were seen when comparing novice and intermediate performances on the adult versus pediatric simulator. Linear regression showed no difference between adult and pediatric experts tested on the adult or pediatric simulator., Conclusions: Experts were more challenged with the pediatric than with the adult suturing task. No difference was noted for overall averaged performance metrics comparing adult and pediatric experts suturing in adult versus pediatric simulators. As a participant's level of expertise improves, a model progressing from larger to smaller domains in the performance of defined laparoscopic tasks may, by virtue of its greater challenge, encourage psychomotor development.

Background: This study analyzes instrument motion for segments of a defined intra-corporeal suturing task in a laparoscopic simulator. We describe a system providing real-time velocity and acceleration assessment in the performance of this task. Analysis of the deconstructed task segments allows targeted assessment and teaching., Methods: A traditional box trainer was fitted with a custom-built motion-tracking system. Participants were stratified into novice, intermediate and expert groups. They performed a defined intra-corporeal suturing task. Real-time data were collected in four degrees of freedom (DOFs) (Roll, Surge, Pitch, Yaw). The task was then deconstructed into four segments: loading needle/pull-through, double-throw knot, first single-throw knot, and second single-throw knot. Motion analysis parameters (MAPs) were studied for each DOF., Results: Sixty-four participants were tested (14 novices, 19 intermediates, 31 experts). The largest difference in MAPs was seen in the 'double-throw knot' segment. MAPs for the 'loading needle/pull-through' segment revealed differences between novices and experts in Roll and Pitch DOFs only. For the 'first single knot' segment, similar MAP trends were noted across all DOFs, with significant differences between novices versus experts and intermediates versus experts. For the 'second single knot' segment, the difference in MAPs was preserved only for novices versus experts., Conclusions: By analyzing motion for a defined suturing task in a laparoscopic simulator, we can gain insight into the specific hand motions distinguishing experts from non-experts. Such information may allow teaching in a more focused, effective and efficient manner.

Background: Laparoscopic models are recognized as important training tools. Lower fidelity systems are used mainly for simpler tasks; an advanced suturing task may allow for additional training of experts. The purpose of this study was to explore the educational role of an advanced suturing task using motion analysis and establish the task's construct validity., Methods: The pediatric laparoscopic surgery (PLS) simulator was customized with motion-tracking hardware and software. Participants were stratified by expertise, then performed an advanced task involving intracorporeal suturing in a vertical plane, with the suture passing superiorly to inferiorly. Traditional PLS scores were calculated, and motion was analyzed in the four degrees of freedom available in laparoscopic surgery (Pitch, Yaw, Roll, and Surge). Data were compared to historic results for a standard suturing task., Results: Sixty participants were recruited (8 novices, 13 intermediates, and 39 experts). Analysis of motion in all degrees of freedom allowed discrimination between participants based on expertise level. Compared with the standard task, PLS scores for the advanced task were significantly lower for intermediates and experts, and the number of extreme motion events was significantly higher, indicating that advanced task is more challenging. In addition, only 76.3% of experts, 76.9% of intermediates, and 37.5% of novices were able to successfully complete the advanced task., Conclusions: Performance of an advanced intracorporeal suturing task allowed discrimination of expertise level. The task's increased complexity may help hone laparoscopic technical skills, particularly among advanced performers, and even allow discrimination of psychomotor expertise within the traditional cohort of experts.

Background: Laparoscopic models for ex vivo up-skilling are becoming increasingly important components of surgical education. This study aims to establish the construct validity and possible educational role of a new laparoscopic box trainer equipped with a motion-tracking device., Methods: A structured questionnaire was used to assign participants into novice, intermediate, or expert categories according to level of experience in minimal access surgery (MAS). Participants carried out a well-defined intracorporeal suturing task. Three specific motion analysis parameters (MAPs)-velocity, acceleration, and range-were measured and analyzed as movements in the four degrees of freedom available in traditional MAS using tracking sensors at the trocar insertion sites., Results: The number of extreme velocity and acceleration events in all four degrees of freedom proved capable of differentiating between participants in the three categories of surgical experience using an ANOVA test (p < 0.001). Post hoc analysis confirmed these differences in the number of extreme velocity and acceleration events between all groups tested except for the velocity of the roll between the intermediates and experts., Conclusion: These findings confirm construct validity for this new laparoscopic box trainer system, which employs a novel analysis based on motion parameters. Motion parameters provide information regarding the overall smoothness of the operator's instrument handling, an important aspect of a surgeon's technique. This preliminary data will be used to design a simulator with real-time motion feedback to enhance its educational value.