Sequential psychomotor skills development in laparoscopic colon surgery
W. P. Geis, A. V. Coletta, J. C. Verdeja, G. Plasencia, O. Ojogho and M. Jacobs
Department of Surgery, University of Chicago School of Medicine, Ill.
OBJECTIVES: To quantify the complexity of each of three skills used in
laparoscopic colon surgery and to quantify the relative complexity of seven
laparoscopic colon procedures on a graduated complexity scale. DESIGN: Five
surgeons used a scale of 1 through 6 to measure the relative complexity of
three laparoscopic skills (intracorporeal mobilization, intracorporeal
devascularization, and intracorporeal anastomosis) to assess the relative
difficulty of seven laparoscopic procedures (right colon resection, sigmoid
colon resection, low anterior resection, Hartmann's procedure, left colon
resection, abdominoperineal resection, and transverse colon resection)
using detailed evaluation of their first 100 laparoscopic colon resections.
SETTING: Three private community hospitals. MAIN OUTCOME MEASURES: The
complexities of intracorporeal mobilization, intracorporeal
devascularization, and intracoporeal anastomosis were recorded for seven
laparoscopic colon procedures. RESULTS: The least complex procedure was
right colon resection, followed in increasing complexity by sigmoid colon,
Hartmann's procedure, low anterior resection, abdominoperineal resection,
left colon resection, and transverse colon resection. The addition of each
laparoscopic skill increased the complexity during each procedure. All
three skills were not required for every procedure. CONCLUSIONS: Since all
procedures do not require all three skills, skills can be learned
sequentially if patients are chosen judiciously. A sequence of laparoscopic
procedures performed by surgeons is recommended. The relative complexities
for each procedure suggest an outline (map) for surgeons to use during
laparoscopic colon surgery.
