Evaluation of self-educational training methods to learn laparoscopic skills - a randomized controlled trial

Background: Evaluation of two different self-educational methods (video assisted learning versus video assisted learning plus a nodal point operation primer) on learning laparoscopic suturing and intracorporal knotting. Methods: Randomized controlled trial at the laparoscopic surgical training center, University of Tubingen with 45 surgical novices first year medical students being pretested for dexterity. After self-educational training for 90 min with either method (Group A: video assisted learning, Group B: video assisted learning plus a nodal point operation primer) participants had to perform five laparoscopic intracorporal knots. Assessed were number of knots completed (maximum of five knots counted, knot integrity, technical proficiency and knotting time per knot. Primary outcome measure is a composed knot score combining knot integrity, technical proficiency and knotting time. Results: Group B (n = 23) achieved a significantly higher composed knot score than Group A (n = 22) (53.3 +/- 8.4 versus 46.5 +/- 13.6 points respectively, p = 0.016). Median knotting time per completed knot was significantly different between Group B and Group A (308 s [100-1221] versus 394 s [138-1397] respectively, p = 0.001). Concerning number of completed knots there was a trend towards more knots achieved in Group B (4.2 +/- 1.2 versus 3.55 +/- 1.4 respectively, p = 0.075). Conclusions: The use of a nodal point operation primer highlighting essential key steps of a procedure augment the success of learning laparoscopic skills as suturing and intracorporal knotting.