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 α=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.