Technical Performance Changes During a Prolonged Laparoscopic Simulation Session in Obstetrics and Gynecology Residents: A Prospective Repeated-Measures Study (Preprint)

BACKGROUND Laparoscopy imposes biomechanical and cognitive demands, but changes in technical performance during prolonged sessions remain poorly characterized. OBJECTIVE This study aimed to assess within-participant changes in technical performance during a 3-hour laparoscopic simulation session METHODS In this prospective repeated-measures study, 20 obstetrics and gynecology residents repeatedly performed three tasks adapted from the Fundamentals of Laparoscopic Surgery (FLS) program (Peg Transfer, Pattern Cutting, and Ligating Loop) over three 1-hour periods of cumulative simulation time (H1–H3). The primary outcome was the within-participant H3−H1 change in the FLS-derived score. Secondary outcomes included other between-period comparisons of the FLS-derived score, changes in individual task scores, task completion time, total instrument path length, total number of movements, and manual dexterity assessed using the Purdue Pegboard Test before and after the session. Perceived workload was assessed using the Surgery Task Load Index (SURG-TLX; 0-100 scale) after H1 and H3. Paired t tests or Wilcoxon signed-rank tests were selected according to the distribution of paired differences. The 95% confidence intervals were not adjusted for multiplicity. Statistical significance for the 49 secondary analyses was assessed using Holm-adjusted P values. RESULTS Mean FLS-derived scores were 194.1 (SD 33.5), 221.0 (SD 28.4), and 229.3 (SD 28.3) points during H1, H2, and H3, respectively. The mean H3−H1 difference was 35.2 points (95% CI 27.7-42.7; P<.001). Scores increased from H1 to H2 (Hodges–Lehmann estimate 29.1 points, 95% CI 23.6-32.5; adjusted P<.001); the increase from H2 to H3 was not statistically significant after adjustment (mean difference 8.3 points, 95% CI 1.6-15.0; adjusted P=.32). From H1 to H3, scores increased for Peg Transfer (mean difference 12.6 points, 95% CI 9.2-16.1; adjusted P<.001) and Pattern Cutting (Hodges–Lehmann estimate 13.8 points, 95% CI 10.9-19.5; adjusted P<.001). Task completion time decreased for all tasks. For Peg Transfer and Pattern Cutting, both total instrument path length and total number of movements decreased significantly after adjustment. Perceived workload was higher after H3 than after H1 (mean SURG-TLX difference 7.5 points, 95% CI 3.5-11.5; adjusted P=.03). Purdue Pegboard Test scores showed no statistically significant changes after adjustment. CONCLUSIONS Technical performance improved during a 3-hour laparoscopic simulation session despite higher perceived workload. The effects of repeated practice could not be separated from those of session duration, and the contribution of compensatory mechanisms remains uncertain. CLINICALTRIAL DOI: 10.17605/OSF.IO/DP35T