Document Type : Original Article


Department of Obstetrics and Gynaecology, AIIMS, Bhopal, Madhya Pradesh, India


BACKGROUND: Simulation‑based training is an important strategy for skill development in a
competency‑based curriculum, especially so for laparoscopic surgery given its unique learning curve,
need for practice, and patient safety concerns. The study was conducted for postgraduates in two
surgical disciplines in a medical college tertiary care center. The study evaluates the acceptability and
utility of structured simulation‑based training for laparoscopic skills. Simulations provide deliberate
practice in the leaner supportive environment.
MATERIALS AND METHODS: The educational intervention was carried out among the 16
postgraduates from year 2 and year 3 of general surgery and obstetrics and gynecology. A structured
training and assessment module was designed and validated, and a 12‑week structured training
on laparoscopic box trainers was given to postgraduates under faculty guidance. Feedback
from postgraduates and faculty was obtained using separate validated questionnaires. The
pre‑ and post‑training assessment scores were compared applying the Wilcoxon matched‑pairs
signed‑rank (2‑tailed) test using the SPSS Windows Version 20.0 (IBM Corporation).
RESULTS: Sixteen postgraduates participated in the study. The median satisfaction score of the
postgraduates was 4 (range 3–5), a scale of a maximum of 5. The group identified faculty feedback,
stepwise skills learning, supportive learning environment, and trainers’ motivation as enabling factors
in the training. The faculty observed that the trainees were effectively engaged. The group mean
improvement scores in percentage were 40.08 for task 1, 42.08 for task 2, 43.13 for task 3, and
45.63 for task 4.
CONCLUSIONS: It is feasible to incorporate faculty‑guided sessions of simulation training in basic
laparoscopy skills for postgraduates in our setup. It is well accepted by the key stakeholders, and
we recommend it to be incorporated in the formal training program.


1. Alameddine MB, Claflin  J, Scally CP, Noble DM, Reames BN,
Englesbe MJ,et al. Resident surgeons underrate their laparoscopic
skills and comfort level compared to attending surgeons. J Surg
Educ 2015;72:1240‑6.
2. SachdevaAK, Buyske J, Dunnington GL, Sanfey HA,Mellinger JD,
Scott DJ, et l. A new paradigm for surgical procedural training.
Curr Probl Surg 2011;48:854‑968.
3. Dreyfus SE. The five‑stage model of adult skill acquisition. Bull
Sci Technol Soc 2004;24:177‑81.
4. Nagendran M, Gurusamy KS, Aggarwal R, Loizidou M,
Davidson BR. Virtual reality training for surgical trainees
in laparoscopic surgery. Cochrane Database Syst Rev
5. Supe A, Prabhu R, Harris I, Downing S, Tekian A. Structured
training on box trainers for first year surgical residents: Does it
improve retention of laparoscopic skills? A randomized controlled
study. J Surg Educ 2012;69:624‑32.
6. Pazin Filho A, Romano MM. Simulation: Conceptual aspects.
Medicine (Ribeirão Preto) 2007;40:167‑70.
7. Varras M, Nikiteas N, Varra VK, Varra FN, Georgiou E, Loukas C.
Role of laparoscopic simulators in the development and
assessment of laparoscopic surgical skills in laparoscopic surgery
and gynecology. World Academy of Science Journal Wasj. March
2020.65‑76. [doi: 10.3892/wasj.2020.41].
8. Dhariwal AK, Prabhu RY, Dalvi AN, Supe AN. Effectiveness
of box trainers in laparoscopic training. J Min Access Surg
9. Hardon SF, Horeman T, Bonjer HJ, Meijerink WJ. Force‑based
learning curve tracking in fundamental laparoscopic skills
training. Surg Endosc 2018;32:3609‑21.
10. Kolozsvari NO, Feldman LS, Vassiliou MC, Demyttenaere S,
Hoover ML. Sim one, do one, teach one: Considerations in
designing training curricula for surgical simulation. J Surg Educ
11. Mannella P, Malacarne E, Giannini A, Russo E, Caretto M,
Papini F, et al. Simulation as tool for evaluating and improving
technical skills in laparoscopic gynecological surgery. BMC Surg
12. Thomas GW, Johns BD, Marsh  JL, Anderson DD. A  review of
the role of simulation in developing and assessing orthopaedic
surgical skills. Iowa Orthop J 2014;34:181‑9.
13. De Win G, Van Bruwaene S, Aggarwal R, Crea N, Zhang Z,
De Ridder D, et al. Laparoscopy training in surgical education:
The utility of incorporating a structured preclinical laparoscopy
course into the traditional apprenticeship method. J Surg Educ
14. Pape‑Koehler C, Immenroth M, Sauerland S, Lefering R,
Lindlohr  C, Toaspern  J, et al. Multimedia‑based training on
Internet platforms improves surgical performance: A randomized
controlled trial. Surg Endosc 2013;27:1737‑47.
15. Scott DJ, Young WN, Tesfay ST, Frawley WH, Rege RV, Jones DB.
Laparoscopic skills training. Am J Surg 2001;182:137‑42.16. Singh AG. Simulation‑based training in laparoscopic
urology – Pros and cons. Indian J Urol 2018;34:245‑53.
17. Satava RM. Surgical education and surgical simulation. World J
Surg 2001;25:1484‑9.
18. Vanderbilt AA, Grover AC, Pastis NJ, Feldman M, Granados DD,
Murithi LK, et al. Randomized controlled trials: A  systematic
review of laparoscopic surgery and simulation‑based training.
Glob J Health Sci 2014;7:310‑27.
19. Vitish‑Sharma P, Knowles J, Patel B. Acquisition of fundamental
laparoscopic skills: Is a box really as good as a virtual reality
trainer? Int J Surg 2011;9:659‑61.
20. Shah PN, Chincholi I. Effectiveness of structured training for
retention of procedural skill in anesthesiology residents. Ann
Med Health Sci Res 2018;8:45‑7.
21. Muthammal R, Mohanraj, Ramprasath. Skill development in
Laparoscopic surgery using endotrainers for House interns in a
Teaching Hospital. IOSR J Dent Med Sci 2018;17:14‑8.
22. Appleton S, Huguelet P. Laparoscopy skills simulation for
the obstetrics and gynecology resident. MedEdPORTAL
23. Al‑Kadi AS, Donnon T, Oddone Paolucci E, Mitchell P, Debru E,
Church N. The effect of simulation in improving students’
performance in laparoscopic surgery: A meta‑analysis. Surg
Endosc 2012;26:3215‑24.
24. Torricelli FC, Barbosa JA, Marchini GS. Impact of laparoscopic
surgery training laboratory on surgeon’s performance. World J
Gastrointest Surg 2016;8:735‑43.
25. Papanikolaou IG, HaidopoulosD, PaschopoulosM, Chatzipapas I,
Loutradis D, Vlahos NF. Changing the way we train surgeons in
the 21th century: A  narrative comparative review focused on
box trainers and virtual reality simulators. Eur J Obstet Gynecol
Reprod Biol 2019;235:13‑8.