• Azhar Rafiq, Francisco Tamariz, Cosmin Boanca, Vladimir Lavrentyev, and Ronald C Merrell.
• Department of Surgery, Virginia Commonwealth University, Richmond, Virginia 23298, USA. arafiq@vcu.edu
• J Surg Educ. 2008 Jul 1; 65 (4): 270-4.

ObjectiveWe have shown previously that achieving competent performance of basic laparoscopic skills is possible in difficult conditions. We hypothesize that real-time performance feedback adds to the quality of proficiency-based simulator training for performance and forces applied to conventional surgical tools while tying square knots and running suture throws.DesignA silk suture was preplaced on a simulated skin pad to assess incision closure by tying square knots and in separate trials to evaluate closure with the task of placing a running suture. The order of task performance was assigned randomly, and each task was repeated 5 times before switching to the second task. In all, 10 repetitions per task were performed by each student. After completion of the second surgical task, the cycle was repeated to test adaptation and retention of motor-skill capabilities. Half the participants were provided with a graphic display in dial format to indicate applied force.SettingBench-top setup of apparatus was performed in a laboratory at Virginia Commonwealth University, Department of Surgery.ParticipantsTwelve second-year medical students with no surgical skills background participated in the study.ResultsResults from the knot-tying task indicated that the average force exerted on tissue forceps by the left hand in the blinded group who performed simple knots actually increased over repeated trials, as opposed to what was achieved by the group that had real-time feedback of their forces being applied. For the running suture, the task average force exerted on surgical tools by both hands was greater in the blind group relative to those viewing real-time graphic feedbacks of forces generated over repeated trials.ConclusionInclusion of real-time objective assessment in evaluation of surgical skills minimizes subjective evaluation of performance capabilities. A direct correlation between real-time feedback regarding force exerted and extent of surgical task completion was noted.

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