Comparing the Variation in Laparoscopic Skills Acquisition in Obstetrics & Gynaecology and General Surgical Trainees. (LAGGS Study)

Laparoscopic surgery (LS) is widely used for an increasing number of procedures in general surgery and obstetrics and gynecology (O&G). However, the psychomotor skills of laparoscopic surgery can be difficult to develop and trainees pursuing a laparoscopic surgical career often face a steep learning curve. Whilst simulation based training can lead to acquisition of transferrable skills, they are not a substitute for the operating theatre.

In both specialties, obtaining adequate exposure to operative work is a multifaceted challenge for the trainees as well as those involved in designing and delivering surgical training. Amongst other factors, NHS pressures driving service provision, European Working Time Directive (EWTD), loss of firm structures, and the cost of training to the trainees themselves have been identified as factors affecting the quality of surgical training in the UK. This is reflected in annual training surveys highlighting concerns over loss of practical training and experience across both specialties.

Whilst the requirements for CCT for general operative skills in open and laparoscopic surgery are comparable in both specialties, the training pathways defer significantly. GS training is 8 years in duration (CT1, CT2, ST3-ST8), whereas O&G consists of 7 years of specialty training (ST1-ST7). The ST1-ST5 years in O&G is mainly devoted to obstetrics and only those trainees pursuing a gynaecological training pathway undertake an intensive period of surgical training in the last two years of their training. The investigators believe there is also earlier exposure to laparoscopy in GS training with a greater volume of laparoscopic work in comparison to O&G training.

So far there is no direct comparison of O&G and GS training pathways and outcomes in laparoscopic skills.

It is known that greater exposure to laparoscopic training is associated with "muscle memory" and may contribute to reducing the physical and mental stress of the surgeon. The investigators would expect trainees to be more efficient at FLS with more laparoscopic surgery exposure. The measurement of muscular and cognitive fatigue can be regarded as a surrogate marker of exposure to laparoscopy giving further insights into the quality of laparoscopic training between the two training programs.