Assessing laparoscopic manipulative skills

The rapid emergence of laparoscopic surgery over the past decade has highlighted the need for teaching and assessing laparoscopic manipulative skills. Most analyses consist of a measurement of the time to complete a specified task and a subjective assessment by an observer. Objective assessments of accuracy in the performance of manipulative skills have been lacking. To quantify both speed and accuracy during laparoscopic skill performance, we have developed a skills assessment device (SAD) using a laparoscopic simulator platform and computer-based skills assessment software that precisely measures an instrument's movement during performance of timed laparoscopic manipulations.

The SAD device measures the time necessary for an operator to complete a task, and the movements of the working end of laparoscopic instruments in three dimensions. Ten nonsurgeons performed 10 repetitions of a standardized laparoscopic manipulation. Data were captured in real time for both hands on a personal computer. Accuracy was determined by calculating the sum of all distances traveled. Duration was measured in seconds. Results are group means.

The time necessary to perform defined laparoscopic manipulative skills improved dramatically during the first 3 repetitions and then stabilized. However, accuracy of manipulations continued to improve over all 10 repetitions.

When untrained subjects are learning a laparoscopic manipulative task, measurement of time alone fails to account for the more protracted learning curve for accuracy. Therefore, devices and training programs that fail to consider objective assessments of accuracy may overestimate laparoscopic proficiency.