Evaluation and impact of minimally invasive surgical simulation on cuff closure in laparoscopic hysterectomies in a gynecologic residency training program

Study Objective: To examine the effect of implantation of simulatorbased practice on surgical proficiency of Ob/Gyn residents in vaginal cuff closure during total laparoscopic hysterectomies. To explore resident evaluation of their comfort level with minimally invasive skills before and after implementation of simulator-based practice. Design: Prospective cohort study. Setting: Academic Ob/Gyn residency program. Patients: 11 upper level Ob/Gyn residents. Intervention: At the beginning of their benign gynecology rotation, 3rd and 4th year residents complete a questionnaire assessing their comfort with laparoscopic skills. The subjects perform a timed laparoscopic cuff closure in a real case and on the simulator. The simulator was based on previously validated models. The residents are randomized into a practice and no practice group. The questionnaire and timed cuff closures are repeated at rotation's end. Measurements and Main Results: Of the 11 residents, 6 randomized into the practice group and 5 randomized into the no practice group. Of those who completed timed cuff closures on the simulator both at the beginning and end of the month (n = 7), 66.7% of the practice group residents had improved compared to 50% of the no practice group. Of those who completed timed cuff closures in real cases at both the beginning and the end of the month (n = 7), 75% of residents in the practice group had improved times compared to 33.3% of the no practice group. Median confidence for unassisted cuff closures increased in the intervention group but did not for the non-intervention group. Median confidence for assisted cuff closures increased in both the intervention and the non-intervention group. Conclusion: There may be a trend toward improvement in both real cases and simulation cuff closures in those residents who were in the practice group as well as an improvement in confidence levels. The data is preliminary and the study is ongoing.