Evolution of laparoscopic education and the laparoscopic learning curve: a review of the literature

Abstract

Background and Objective: There is a significant learning curve associated with performing laparoscopic surgery. This is magnified for more complex laparoscopic operations and novel teaching approaches are needed to prepare the next generation of surgeons for independent practice. This narrative literature review aims to examine current laparoscopic surgical training and the laparoscopic learning curve. We also aim to discuss methods and future directions that hold promise for shortening the laparoscopic learning curve. Methods: A literature search was performed through the MEDLINE database. The search terms included “surgical learning curve”, “laparoscopic learning curve”, “laparoscopic education”, and “laparoscopic simulation”. The results were reviewed until thematic saturation was reached. Key Content and Findings: Many trainees finish surgical residency not yet prepared for independent practice in a wide range of laparoscopic procedures. Several adjuncts have been shown to improve trainees’ skills, including basic and advanced simulation-based training. These simulation curricula have shown promise in remote and home-based settings to allow trainees to learn laparoscopic skills at flexible times and locations. To quantify the progress of a surgeon’s training, many authors have sought to define laparoscopic procedures’ learning curve. The length of operative time has been often used to measure the learning curve; however, other methods of defining the learning curve may be more telling. Several factors improve laparoscopic education and skill acquisition, and notably learning curves may change as new laparoscopic operations mature and have stable platforms. Key factors to shorten the learning curve include training and mentoring from expert-level surgeons, clear delineation of expectations for trainee skill progression, and formative evaluation of performance in the operating room and simulation setting. Conclusions: Defining learning curves is challenging and can be arbitrary. Nonetheless, as the complexity of laparoscopy continues to evolve, improving laparoscopic education and confirming provider competency is increasingly important to ensure patient safety. In addition to valuable intra-operative training, simulation and virtual training with skilled mentorship have emerged as key adjuncts in laparoscopic skill acquisition to shorten the laparoscopic learning curve in a safe and low-stakes environment.

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