The impact of the learning curve on adhesion formation in a laparoscopic mouse model.

OBJECTIVE To evaluate the impact of surgeon training on adhesion formation in a laparoscopic mouse model. Laparoscopic surgery and bowel manipulation was demonstrated to enhance postoperative adhesion formation. DESIGN Prospective randomized, controlled trial. SETTING University laboratory research center. ANIMAL(S) 200 BALB/c and 200 Swiss female mice. INTERVENTION(S) Adhesions were induced by opposing bipolar lesions and 60 minutes of pneumoperitoneum. Each surgeon operated on 80 mice (40 Swiss and 40 BALB/c), the only variable thus being his/her increasing experience. Some surgeons were already experienced gynecologists, others were starting their training. MAIN OUTCOME MEASURE(S) End points were the duration of surgery while performing the lesions. The adhesion formation was scored quantitatively (proportion and total) and qualitatively (extent, type, and tenacity) after 7 days. RESULT(S) With training, duration of surgery and adhesion formation decreased exponentially for all surgeons, whether experienced or not. Experienced surgeons had initially a shorter duration of surgery, less adhesion formation, and less de novo adhesions than inexperienced surgeons. CONCLUSION(S) These data suggest that laparoscopic skills improve with training, leading to a decrease in the duration of surgery and formation of adhesions. Therefore completion of a standardized learning curve should be mandatory when initiating adhesion formation studies both in laboratory or clinical setting.