Assessing intermediate laparoscopic training: Progression toward surgical proficiency

While simulation for minimally invasive surgery (MIS) has become standard for training surgeons, existing programs often focus only on essential skills. We seek to validate a simulation program featuring intermediate-level assessments for pediatric surgeons to enhance their laparoscopic skills beyond essentials. Participants were categorized based on the number of MIS surgeries performed and level of training: G1 (beginners), G2 (intermediates), and G3 (experts). Employing MTBOX1®, we conducted six exercises within predefined timeframes (three-dimensional static & dynamic transfer, manipulation of long structures, needle handling, and vertical running sutures). Participants' scores were determined by the operation: (objectives achieved / time in seconds) × 100. After the validation process, a different set of participants were enrolled and tested in long-term courses. The mean scores considering GOALS assessment were analyzed at the beginning and end of the intensive stage of the course and compared. Among the first 14 participants, 28.5 % were beginners, 50 % intermediates, and 21.5 % experts. Mean general scores were higher with ascending expertise levels: beginner: 0.37, intermediate: 0.63, experts: 1.4. indicating that the simulation exercises effectively distinguished higher-level participants from beginners. Among the 34 participants of the second phase, there was a significant difference between initial general score and the general score at the last (1st: 3.39 ± 0.44 vs. last: 3.79 ± 0.49, p = 0.017). These results validate the effectiveness of our intermediate skill assessments, illustrating a positive correlation between increasing expertise levels and enhanced performance