Low-hanging Fruit

In Brief Introduction Low-cost, high-fidelity models for training in advanced laparoscopic surgery techniques are not currently available. The objective of this study was to evaluate a model and assessment protocol for developing associated fine, precise laparoscopic dissection skills with accompanying surgical decision making. Methods Novice to expert laparoscopists (n = 41) were asked to remove the peel of a clementine in as few pieces as possible, separate and remove all albedo from and between all fruit segments, and return the clementine to as close to its natural state as possible with completely closed skin (sutured). Clinical decision making included deciding when unacceptable segment damage would result by removing difficult-to-extract albedo, analogous to treating lesions or metastases through other methods, rather than risking damage to vital anatomic structures. Faculty assessed deidentified video-recorded performances. Data analyses included analysis of variance with Bonferroni post hoc. Results A single-performance construct (operative ability) with 2 scoring dimensions (surgical skills and clinical judgment) was confirmed through factor analysis. There were significant performance differences between all experience levels (F2,41 = 59.175, P < 0.000). There were no statistical time differences between the groups. Conclusions Validation of this low-cost, easily facilitated model for developing advanced laparoscopic surgical skills may support the preparation of residents and fellows and provide a platform for skill acquisition, assessment, and basic critical thinking for performing laparoscopic tasks. Current laparoscopic simulation models fail to train learners in advanced minimally invasive surgical skills such as proper tissue handling and cognitive-based aspects of surgery including decision making and operative planning. This study evaluated the ability of a low-cost, high-fidelity model to differentiate between novice and expert surgical specialists in the performance of a laparoscopic surgical dissection of a clementine. The clementine model and associated assessment system may provide an adequate training program to include precision dissection as well as planning and clinical decision-making skills in the development of laparoscopic skills.