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Laparoscopic learning curves.

OBJECTIVES
Laparoscopic learning curves are slow, and there are no uniform surgical skill acquisition models. Therefore, our objective was to assess a laparoscopic skill learning program in individuals without any surgical experience, analyzing the learning curve by means of a certified custom-made simulator, and evaluating whether previous surgical experience had an impact on the learning curve.


MATERIAL AND METHODS
A certified custom-made simulator and laparoscopic instruments were used to assess 20 university students who performed 10 repetitions of 3 exercises of growing difficulty (eye-hand coordination, hand-hand coordination, and cutting). Three parameters were analyzed: total time with each hand, total mistakes with each hand, and three items of the OSATS technical skill scale. The two first exercises were compared with a group of 14 experienced surgeons. Statistical analysis using repeated-measures Anova and Student's t-test was carried out (p < 0.05).


RESULTS
Significant time improvement with each repetition was demonstrated in the three exercises. Curve stabilization was faster in surgeons (2-4 repetitions) than in students (8-9). Time reduction was noted in the first and second exercises in both groups, with 44.08% and 33.1% shorter times, respectively.


CONCLUSIONS
Individuals without surgical experience acquired basic laparoscopic skills using a custom-made simulator, which allows simple surgical techniques to be carried out in an inexpensive, accessible fashion. Previous surgical experience was associated with a shorter learning curve. The custom-made simulator allowed individuals with and without surgical experience to be distinguished from each other.