APGO

Study Objective: Create a novel, cost efficient surgical simulation model for training laparoscopic suturing of the vaginal cuff and present evidence regarding its validity as a training and assessment tool.

Methods: Construct validity was determined by comparing the scores on the Global Operative Laparoscopic Assessment of Laparoscopic Skills (GOALS) scale between ‘expert’ and ‘trainee’ groups as graded by two masked expert viewers. Our analysis includes the previously validated 5-question GOALS score and an 8-question score including the GOALS scale plus three additional metrics. The Wilcoxon rank-sum test was used to compare differences in scale scores and operating times between the groups. The Contrasting Groups method was used to determine the minimum passing score.

Results: Over 90% of the participants ‘agreed’ or ‘strongly agreed’ that the model closely resembled live surgery. Advanced Novices (PGY5-PGY7) performed comparably to the Experts, with similar GOALS score (Advanced Novice 22 vs. Experts 22.5, p=0.562) and total score (36 vs. 37.5, p=0.424). In contrast, the Early Novices (PGY2-PGY4) had significantly lower GOALS score (Early Novices: 16 vs. Experts: 22.5, p<.001) and total score (27 vs. 37.5, p<.001). The passing 8-question total score was 32 (see Figure). 9 of 10 Expert attempts (90%) achieved the passing total score, equal to the success rate for Advanced Novice attempts (9/10=90%), versus only 7 of 30 Early Novice attempts (23.3%).

Conclusion: This novel surgical simulation model allows novice surgeons to practice techniques of laparoscopic suturing to achieve competence prior to performing live surgery.