EXTRAPOLATION OF SURGICAL SKILLS OUTSIDE THE OPERATING ROOM: A CASCADE MODEL OF MASTERING LAPAROSCOPIC TECHNOLOGIES BY POSTGRADUATE STUDENTS
DOI:
https://doi.org/10.11603/m.2414-5998.2026.2.16453Keywords:
laparoscopy, OSATS, cascade training model, simulation training, learning curveAbstract
Modern laparoscopic surgery places high demands on a specialist's psychomotor skills, as working in a confined space and with 2D visualization requires a complete deconstruction of basic motor reflexes. The traditional "master-to-student" model directly in the operating room is associated with an increased risk of iatrogenic complications. Shifting the "learning curve" outside of clinical practice is critically necessary to ensure patient safety. The aim of the study was the scientific substantiation and evaluation of the effectiveness of a comprehensive cascade model for training resident physicians for laparoscopic interventions, which combines theoretical training, simulation training on box trainers, and practice in a teaching operating room on experimental animals. A prospective study involved 12 resident physicians without prior experience in independent surgery. The program included three blocks: theoretical-morphological, trainer-based (box trainers), and practical (teaching surgeries on experimental animals). Technical skills were assessed using the OSATS scale at three points: T0 (baseline control), T1 (after trainers), and T2 (after practice on a living organism). Statistical processing was performed using Welch's ANOVA and Tukey's post-hoc test in Jamovi. A statistically significant increase in proficiency was established across all domains of the OSATS scale (p < 0.001). The simulation stage provided a rapid increase in movement ergonomics by 3 times and instrument handling technique by 3.2 times. However, only experimental animals allowed for a significant improvement in the delicacy of tissue manipulation, as indicated by an additional increase of 30.4 % (p < 0.01). The final quality of surgical performance at stage T2 increased by 4.5 times compared to T0. The cascade training model is a highly effective training tool, where box trainers form the technical base, and the teaching operating room serves as an indispensable bridge for mastering the "feeling of tissue." The small-group training format allows for the optimization of the learning curve and guarantees the quality of preparation before entering clinical practice.
References
Tetteh, E., Wang, T., Kim, J. Y., Smith, T., Norasi, H., Van Straaten, M. G., Lal, G., Chrouser, K. L., Shao, J. M., & Hallbeck, M. S. (2024). Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations. American journal of surgery, 235, 115551. https://doi.org/10.1016/j.amjsurg.2023.11.005 DOI: https://doi.org/10.1016/j.amjsurg.2023.11.005
Wright Jr., J. R., & Schachar,, N. S. (2020). Necessity is the mother of invention: William Stewart Halsted’s addiction and its influence on the development of residency training in North America. Canadian journal of surgery. Journal canadien de chirurgie, 63(1), E13–E19. https://doi.org/10.1503/cjs.003319 DOI: https://doi.org/10.1503/cjs.003319
Cullinan, D. R., Schill, M. R., DeClue, A., Salles, A., Wise, P. E., & Awad, M. M. (2017). Fundamentals of Laparoscopic Surgery: Not Only for Senior Residents. Journal of surgical education, 74(6), e51–e54. https://doi.org/10.1016/j.jsurg.2017.07.017 DOI: https://doi.org/10.1016/j.jsurg.2017.07.017
Peláez Mata, D., Herrero Álvarez, S., Gómez Sánchez, A., Pérez Egido, L., Corona Bellostas, C., & de Agustín Asensio, J. C. (2021). Laparoscopic learning curves. Curvas de aprendizaje en laparoscopia. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica, 34(1), 20–27.
Reitano, E., de'Angelis, N., Schembari, E., Carrà, M. C., Francone, E., Gentilli, S., & La Greca, G. (2021). Learning curve for laparoscopic cholecystectomy has not been defined: A systematic review. ANZ journal of surgery, 91(9), E554–E560. https://doi.org/10.1111/ans.17021 DOI: https://doi.org/10.1111/ans.17021
Suguita, F. Y., Essu, F. F., Oliveira, L. T., Iuamoto, L. R., Kato, J. M., Torsani, M. B., Franco, A. S., Meyer, A., & Andraus, W. (2017). Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications. Surgical endoscopy, 31(10), 3939–3945. https://doi.org/10.1007/s00464-017-5426-z DOI: https://doi.org/10.1007/s00464-017-5426-z
Tariq, S., Cainelli, F., Sahraoui, A. Z., & Achar, A. (2025). Extended Reality in Laparoscopic Cholecystectomy Training: A Systematic Review and Meta-analysis. The Journal of surgical research, 316, 143–150. https://doi.org/10.1016/j.jss.2025.10.047 DOI: https://doi.org/10.1016/j.jss.2025.10.047
Chan, K. S., Teo, Z. H. T., Oo, A. M., Junnarkar, S. P., & Shelat, V. G. (2023). Learning Curve of Laparoscopic Common Bile Duct Exploration: A Systematic Review. Journal of laparoendoscopic & advanced surgical techniques. Part A, 33(3), 241–252. https://doi.org/10.1089/lap.2022.0382 DOI: https://doi.org/10.1089/lap.2022.0382
Igaki, T., Kitaguchi, D., Matsuzaki, H., Nakajima, K., Kojima, S., Hasegawa, H., Takeshita, N., Kinugasa, Y., & Ito, M. (2023). Automatic Surgical Skill Assessment System Based on Concordance of Standardized Surgical Field Development Using Artificial Intelligence. JAMA surgery, 158(8), e231131. https://doi.org/10.1001/jamasurg.2023.1131 DOI: https://doi.org/10.1001/jamasurg.2023.1131
Dudchenko M., Kravtsiv M., Ivashchenko D., Prykhidko R., Shevchuk M., Zaiets S. & Zezekalo Ye. (2023). Bazovi laparoskopichni navychky v khirurhii [Basic laparoscopic skills in surgery] Navchalnyi posibnyk Tutorial, Lviv: Vydavnytstvo "Mahnoliia 2006", 248 s. [in Ukrainian].
