Comparing Laparoscopic Skills Training for Gynecologic Residents Across Two Established Curricula

To compare the effectiveness of the Fundamentals of Laparoscopic Surgery (FLS) and Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) manual skills curricula in preparing obstetrics and gynecology residents for laparoscopic vaginal cuff closure, using both objective performance metrics and subjective assessments.

A randomized, blinded, and controlled study was conducted in a single institution with an obstetrics and gynecology residency program. Nine residents without prior FLS or EMIGS certification were randomized to complete either the FLS or EMIGS manual skills curriculum over 28 days. Participants were video-recorded completing five curriculum-specific tasks, the opposing curriculum without prior practice, and a laparoscopic vaginal cuff closure using barbed suture. The primary outcome was performance on the cuff closure task, assessed using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) questionnaire. Secondary outcomes included individual task scores, total manual skill scores, and post-training survey responses.

There were no significant differences in total manual skills scores between groups (P = .62). FLS-trained participants scored significantly higher on intracorporeal knot tying (P = .0085). However, EMIGS-trained residents achieved higher scores on the vaginal cuff closure task across all postgraduate year (PGY) levels. Subjectively, though most participants found the programs dissimilar, all participants reported skill improvement. EMIGS trainees expressed lower confidence in knot tying, but most agreed EMIGS more closely resembled real-world laparoscopic surgery.

These findings support the use of EMIGS as a gynecologic-specific simulation tool in surgical education, although further research with larger numbers of participants are needed to confirm these observations.