What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey

Neal E Seymour; Dmitry Nepomnayshy; Suvranu De; Erika Banks; Daniel M Breitkopf; Ryan Campagna; Carlos Gomez-Garibello; Isabel Green; Garth Jacobsen; James R Korndorffer Jr; John Minasi; Allan Okrainec; E Matthew Ritter; Ganesh Sankaranarayanan; Steven Schwaitzberg; Nathaniel J Soper; Melina Vassiliou; Maryam Wagner; Boris Zevin

doi:10.1007/s00464-023-10238-z

What are essential laparoscopic skills these days? Results of the SAGES Fundamentals of Laparoscopic Surgery (FLS) Committee technical skills survey

Surg Endosc. 2023 Oct;37(10):7676-7685. doi: 10.1007/s00464-023-10238-z. Epub 2023 Jul 30.

Authors

Neal E Seymour¹, Dmitry Nepomnayshy², Suvranu De³, Erika Banks⁴, Daniel M Breitkopf⁵, Ryan Campagna⁶, Carlos Gomez-Garibello⁷, Isabel Green⁵, Garth Jacobsen⁸, James R Korndorffer Jr⁹, John Minasi¹⁰, Allan Okrainec¹¹, E Matthew Ritter¹², Ganesh Sankaranarayanan¹³, Steven Schwaitzberg¹⁴, Nathaniel J Soper¹⁵, Melina Vassiliou¹⁶, Maryam Wagner⁷, Boris Zevin¹⁷

Affiliations

¹ Department of Surgery, University of Massachusetts Chan Medical School-Baystate Health, 759 Chestnut Street, Springfield, MA, 01199, USA. neal.seymour@baystatehealth.org.
² Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA.
³ College of Engineering, Florida A&M University, Tallahassee, FL, USA.
⁴ Department of Obstetrics & Gynecology, NYU Long Island School of Medicine, Mineola, NY, USA.
⁵ Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
⁶ Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA.
⁷ Institute of Health Sciences Education, McGill University, Montreal, Canada.
⁸ Department of Surgery, University of California San Diego, San Diego, CA, USA.
⁹ Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ Bon Secours Medical Group, Greenville, SC, USA.
¹¹ Department of Surgery, University of Toronto, Toronto, Canada.
¹² Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
¹³ Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
¹⁴ Department of Surgery, University at Buffalo Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA.
¹⁵ Department of Surgery, University of Arizona College of Medicine Phoenix, Phoenix, AZ, USA.
¹⁶ Department of Surgery, McGill University, Montreal, Canada.
¹⁷ Department of Surgery, Queen's University School of Medicine, Kingston, ON, USA.

PMID: 37517042
DOI: 10.1007/s00464-023-10238-z

Abstract

Introduction: The Fundamentals of Laparoscopic Surgery (FLS) program tests basic knowledge and skills required to perform laparoscopic surgery. Educational experiences in laparoscopic training and development of associated competencies have evolved since FLS inception, making it important to review the definition of fundamental laparoscopic skills. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) assigned an FLS Technical Skills Working Group to characterize technical skills used in basic laparoscopic surgery in current practice contexts and their possible application to future FLS tests.

Methods: A group of subject matter experts defined an inventory of 65 laparoscopic skills using a Nominal Group Technique. From these, a survey was developed rating these items for importance, frequency of use, and priority for testing for FLS certification. This survey was distributed to SAGES members, recent recipients of FLS certification, and members of the Association of Program Directors in Surgery (APDS). Results were collected using a secure web-based survey platform.

Results: Complete data were available for 1742 surveys. Of these, 1143 comprised results for post-residency participants who performed advanced procedures. Seventeen competencies were identified for FLS testing prioritization by determining the proportion of respondents who identified them of highest priority, at median (50th percentile) of the maximum survey scale rating. These included basic peritoneal access, laparoscope and instrument use, tissue manipulation, and specific problem management skills. Sixteen could be used to show appropriateness of the domain construct by confirmatory factor analysis. Of these 8 could be characterized as manipulative tasks. Of these 5 mapped to current FLS tasks.

Conclusions: This survey-identified competencies, some of which are currently assessed in FLS, with a high level of priority for testing. Further work is needed to determine if this should prompt consideration of changes or additions to the FLS technical skills test component.

Keywords: Laparoscopic skills; Skills assessment; Surgical competency.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Clinical Competence
Humans
Internship and Residency*
Laparoscopy* / education
Surgeons*
Surveys and Questionnaires