Acquiring surgical skills: a comparative study of open versus laparoscopic surgery

A preliminary study to evaluate the feasibility of a protocol for comparing the learning curves for open and laparoscopic surgical procedures.

Thirteen pre-clinical medical students with no previous surgical training were given intensive coaching in open and laparoscopic surgical techniques for 12 weeks. At the end of this period, their open and laparoscopic skills were assessed by three independent examiners. Individual and aggregate ability scores in various aspects of open and laparoscopic surgery and the time taken to perform the procedures were compared using Student's t-test.

There was no statistically significant difference in the overall scores by the two different techniques ( p=0.057 ). However, differences between the two techniques were significant in certain criteria including tissue dissection (p=0.024), tidiness of gall bladder (p=0.034 ) and liver ( p=0.016 ) specimens and the time taken for the two techniques ( p < or = 0.001 ).

This study suggests that when inexperienced subjects are given equal training in laparoscopy and open surgery, the overall skills acquired were similar by both methods when assessed after 6 weeks. However, on detailed analysis of the different components of surgery, the laparoscopic skills were deficient in finer dissection, identification of correct planes and two-dimensional perception when compared to open surgery and required more operative time. Our study group perceived that laparoscopy was more difficult to learn than open surgery even after the training. The study group also felt that the training in basic surgical skills during their undergraduate careers would make them more interested in studying surgery and choosing it as a career.