Expert Videotape Analysis and Critiquing Benefit Laparoscopic Skills Training of Urologists

INTRODUCTION: Teaching laparoscopic skills has become the focus of the latest generation of hands-on laparoscopic courses. METHODS: Thirty-four practicing urologists, ages 31 to 61 years (mean, 46.6 years) with laparoscopic experience (range, 0 to 200, mean, 27.6 cases), 32 of whom had taken prior American Urological Association (AUA) laparoscopy courses, participated in an AUA-sponsored hands-on laparoscopic skills course over a 2-day period in August 2002 or March 2003. They all took a knowledge assessment examination and performed standardized tasks (rope passing, ring placement, and laparoscopic suturing and knot tying) at the beginning and the end of the course with a videotape analysis and critique. Prior to the repeat-skills assessment, each participant was individually critiqued and instructed based on a videotape review of their initial performance. The urologists also participated in a porcine laboratory and a pelvic trainer session totaling 6 hours between skills assessments. None of the participants had performed significant laparoscopic suturing prior to the course. RESULTS: Using Wilcoxon's signed rank test, the participants improved from a mean of 119.32 seconds to 98.36 seconds with the rope pass (P= 0.0001), and with the ring placement from a mean of 9.70/minute to 12.09/minute (P=0.0001). All participants had significantly fewer false passes (mean, 9.35 compared with 5.21) during repeat skills assessments (P=0.0001). Participants improved from 0.54 sutures/minute to 1.22 sutures/ minute following the video critique and practice (P=0.0001). Degree of laparoscopic experience (number of cases), age of the urologist, and precourse knowledge (examination score) had no significant bearing on results in the initial skills assessment or in the improvement of task time (Spearman correlation coefficients). CONCLUSION: Urologists with some laparoscopic experience (mean 27.6 cases) can improve laparoscopic skills using mentored videotape analysis and experience gained from a 2-day hands-on course. Prior knowledge, degree of experience, and urologist age had no significant bearing on performance in this setting.