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IntroducciónLa complejidad de la cirugía laparoscópica hace necesario un entrenamiento específico fuera del quirófano para acortar la curva de aprendizaje y reducir la morbilidad. El objetivo del estudio es analizar la progresión en habilidades laparoscópicas tras un programa de entrenamiento en laboratorio.Material y métodosEstudio prospectivo de un programa de entrenamiento de residentes de 4 semanas anuales (20 h semanales) basado en anastomosis en endotrainer, realizado entre 2004 y 2007. Los parámetros principales fueron tiempo y número de anastomosis necesarias hasta llegar a una correcta ejecución. Una vez completada, la anastomosis se revisó conjuntamente mediante un residente y un monitor. Se registraron tiempo de ejecución y fallos anastomóticos (sutura floja, eversión de bordes y fuga).ResultadosDoce residentes realizaron 189 anastomosis yeyunoyeyunales (AYY) (media: 15,8) y 197 anastomosis gastroyeyunales (AGY) (media: 16,4). El tiempo medio de las AYY fue de 72,7min y el de las AGY fue de 87,2min. Se observó una gran reducción en el tiempo de ejecución desde el comienzo al final del programa. El porcentaje de anastomosis incorrectas disminuyó en función del tiempo de entrenamiento: el 26,6; el 21,8; el 17,1; el 17; el 16,1 y el 10,5% después de 20; 40; 60; 80; 100 y 120h, respectivamente. Considerando la reducción, tanto en tiempo de ejecución como en el índice de anastomosis incorrectas, después de 70h de entrenamiento la curva de aprendizaje alcanzaba una meseta.ConclusionesEl entrenamiento en endotrainer basado en anastomosis intestinales (tanto AYY o AGY) constituye un método útil de entrenamiento laparoscópico. Después de un entrenamiento de 70h se aprecia poca progresión (AU)

BackgroundThe complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program.Material and methodsProspective study of surgical resident training based on anastomosis performance on an “endotrainer”. The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded.ResultsTwelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70h of training the learning curve reaches a plateau zone.ConclusionsIntestinal anastomosis (either JJA or GJA) performed in “endotrainer” is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit (AU)

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BACKGROUND: The complexity of laparoscopic surgery makes specific training out of the operating rooms necessary to shorten learning curves and to minimise morbidity rates. Our aim was to analyse the increase in laparoscopic skills after completion of a laboratory training program. MATERIAL AND METHODS: Prospective study of surgical resident training based on anastomosis performance on an "endotrainer". The program consisted of 4 weeks per year (20h per week) between 2004 and 2007. The outcome measures were the time and number of anastomosis necessary to perform a proper anastomosis. Upon completion, the anastomosis was checked by both trainee and evaluator and quality was assessed. Time and technical failures (loose suture, edge eversion, leakage) were recorded. RESULTS: Twelve surgical residents were trained. They performed 189 jejuno-jejunal anastomoses (JJA), mean 15.8 per resident and 197 gastro-jejunal anastomoses (GJA), mean 16.4 per resident. The performance mean time was 72.7 min for JJA and 87.2 for GJA. There was a marked reduction in time from the beginning to completion of training. The percentage of flawed anastomosis decreased with training: 26.6%, 21.8%, 17.1%, 17%, 16.1% and 10.5% after 20, 40, 60, 80, 100 and 120 h, respectively. Bearing in mind reduction in both performance time and flawed anastomosis rate, it appears that after 70 h of training the learning curve reaches a plateau zone. CONCLUSIONS: Intestinal anastomosis (either JJA or GJA) performed in "endotrainer" is a suitable model for laparoscopic training, without the need of live animals. After a training period of 70 hours, the improvement seems of little benefit.

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