Optimising Skill Acquisition for Laparoendoscopic Single-Site Surgery using The Time-Lag Model

Introduction: Acquiring skills for Laparoendoscopic Single-Site Surgery (LESS) is complex and shown to have a very steep learning curve. We aimed to develop and test the novel concept of Time-Lag for LESS skill acquisition using an ex-vivo training module. Methods: We used a Time-Lag Camera-Monitor System that allows for a 2.0 second delay between real-time hand movement and the perception of the movement on the monitor. We tested the impact of time-lag on the time taken to learn to perform a simulated Vesicourethral Anastomosis (VUA) by taking two groups of 3 novices and training the first group to perform the procedure with the time-lag system, and the second without the time-lag. Once each novice could perform the procedure satisfactorily, each group was timed in performing the VUA in a real-time setting. Results: The group who had initially trained with the time-lag system performed the final VUA 1.8 times faster than the second group. Video analysis showed that novices who trained using the time-lag system had reduced intention anxiety compared to the second group. Conclusions: The Time-Lag model has potential application in acquiring skills for LESS. It could be used for preliminary skill acquisition in other laparoscopic procedures during training.