A Comparative Study of Laparoscopic Skills Between Novices and Experts: How to Steepen the Learning Curve.

Introduction and aim Laparoscopic surgery has revolutionized the field of surgery over the past few decades. The learning curve in laparoscopy is known to be slow, flat, and complex. This study aims to conduct a comparative analysis of laparoscopic skills, specifically focusing on suturing, knot tying, and needle handling, between novices and experts. The purpose is to objectively quantify the disparities in skill proficiency, identify specific areas needing improvement in training curricula, and contribute to the development of more effective training methodologies for emerging laparoscopic surgeons. Methods Residents from different specialties and institutions had their laparoscopic training and evaluation sessions recorded during their curriculum and compared with the performance of experienced surgeons from the Hôtel-Dieu de France University Hospital (Beirut, LBN) during live surgeries. This comparative study was based on the universally recognized Global Operative Assessment of Laparoscopic Skills (GOALS) score and an assessment of a detailed set of laparoscopic skills and techniques used during needle handling and knot tying. Results Twenty-one tasks performed by novices and 11 tasks performed by experts were considered. A significant difference was found in the GOALS score between the two groups (experts: 23.4/25; novices: 15.9/25). Moreover, a statistically significant difference was found to be present in favor of the experts in the following skills/techniques: using thread handling and forceps rotation for needle manipulation, laying the needle on a fixed driver arm before grasping it, using needle curvature for knot tying, using upward-facing forceps convexity when tying, using an open thread loop before tying, thread handling capacity, knot tying capacity, and number of needle skills performed per task. Conclusion This study demonstrates that many micro-steps in laparoscopic suturing are more prevalent among expert surgeons than among trainees. Incorporating these micro-steps into training could significantly accelerate learning curves, enabling trainees to refine their skills more efficiently and keep pace with the latest surgical advancements in their specialties.