Surgical education
Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil?

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Abstract

Background

For all surgical procedures, a surgeons’ learning curve can be anticipated during which complication rates are increased. The aims of this study were to evaluate individual learning curves for a group of surgeons performing laparoscopic fundoplication and to evaluate if the Procedicus MIST-simulator (Mentice Inc., Göteborg, Sweden) accurately predicts surgical performance.

Methods

Twelve Nordic centers participated, each contributing with a “master” and a “pupil” surgeon. The pupils were tested in the simulator and thereafter performed their first 20 supervised operations. All procedures were videotaped and evaluated by 3 independent reviewers.

Results

A significant decrease in operative time (P <0.001) and a trend (P = 0.12) toward improved score were seen during the series. The master significantly affected the pupil’s score (P =0.0137). The simulator-test showed no correlation with the operative score.

Conclusions

Individual learning curves varied, and the teacher was shown to be the most important factor influencing the pupil’s performance score. The correlation between assessed performance and patient outcome will be further investigated.

Section snippets

Material and methods

The study group was confined to 12 pairs of “master” and “pupil” surgeons from different Nordic centers. Each master was a fully trained surgeon with considerable experience in laparoscopic fundoplication. The pupil was a surgeon under training with experience in laparoscopic surgery in general but not in laparoscopic fundoplication specifically. The intent was to teach the pupil to perform this procedure. Each master defined his or her “gold standard” by fully describing the operative

Results

Two hundred twenty-one patients were included in the study. Not all centers included 20 patients for various reasons; 5 pupil procedures were still assessed for these centers with a narrowed interval. The conversion rate was 3 % (6 of 221), and postoperative hospital stay was 3 days in the median (interquartile range 1 day). There was no significant decrease in hospital stay during the series. Eight complications were reported: 6 patients with dysphagia were treated with endoscopy and

Discussion

When the learning curve in laparoscopic fundoplication is described, measurements such as conversion rate, complications, and operating time are traditionally used [1], [3], [7]. For obvious reasons, patient outcome is the most important long-term quality measurement, but this can be considered somewhat blunt. Watson et al [1] demonstrated different aspects of the learning curve for laparoscopic fundoplication in 280 cases performed by 11 surgeons in a single institution study. In their

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