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Am J Surg. 2007 Feb;193(2):269-73.

A comparison of single- and multiple-stage approaches to teaching laparoscopic suturing.

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  • 1Surgical Skills Centre at Mount Sinai Hospital, Department of Surgery, The University of Toronto, The Wilson Centre, 200 Elizabeth Street, Eaton South 1E 583, Toronto, Ontario, Canada M5G 2C5. adam.dubrowski@gmail.com



This study assessed the effects of learning laparoscopic knot-tying through a series of progressively more difficult steps versus learning the skill in full complexity.


Junior residents (N = 24) practiced either (1) suturing in full complexity under 2-dimensional conditions or (2) simple cone transfer drills under 3-dimensional and then 2-dimensional conditions, followed by suturing under 3-dimensional and then 2-dimensional conditions. Pre-, post-, and delayed (1 week) laparoscopic suturing performances were assessed by using objective motion efficiency variables and final product analyses.


Both groups showed similar improvements on all measures, which were well retained over the 1-week period (P < .01).


Despite spending less time practicing actual suturing, the group of residents who progressed through the sequence of steps performed as well as those who practiced the entire task in its full complexity, a finding that has implications for minimizing teaching resources and training costs.

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