Evaluating suturing skill improvement for pediatric minimally invasive esophageal anastomosis model: an observational cohort study based on simulator training

The study aimed to evaluate the enhancement of minimally invasive surgery (MIS) suturing skills through intensive simulator training, to compare various experimentally measured movement parameters with the established scoring system and to identify movement parameters that may be crucial for achieving proficiency. 55 participants of the intensive practical course of endoscopic surgery in children were included. Training commenced with daily single surgical knot practice, progressed to executing on the final day an anastomosis resembling those performed in esophageal atresia repair. The training effectiveness was gauged by the successful completion of anastomosis. Skills were evaluated by simulator equipped with specialized sensors, which converted data into a set of instrument movement parameters. Additionally, two researchers assessed skills using recorded videos and the objective structured assessment of technical skills (OSATS) questionnaire. Significant improvements in single surgical knot proficiency were noted each day, specifically in metrics: time, movement economy, smoothness, acceleration, instrument activity, and overall score. Strong correlation was observed between automated and human assessments. 48/55 participants attempted anastomosis on the final day, among whom 70% (34/48) attained success (median score 5.1/10, only 16.7% scored above 7/10). Movement economy and instrument distance covered emerged as the most relevant predictors of the anastomosis success. Intensive simulation training significantly enhances endoscopic suturing skills.