Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying

Abstract

Background: Training of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK.

Results: The study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase ₁, a baseline test was performed (T₁, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T₂, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T₃, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups.

Conclusions: This study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.

Keywords: Hand-eye coordination; Intra-corporeal knot tying; Laparoscopy; Learning curve; Training.

Fig. 1

Hand-eye coordination (HEC). Individual learning curves. Participants performed 69 consecutive repetitions (R0–R68) of the task (G1, with both the dominant hand and the non-dominant hand; G2, with the dominant hand only; G3, none). The scores were plotted and individual learning curves were observed, fitting to one- or two-phase exponential decay model according to participants’ performance

Fig. 2

Hand-eye coordination (HEC). Group learning curves. Participants performed 69 consecutive repetitions (R0–R68) of the task (G1, with both the dominant hand and the non-dominant hand; G2 with the dominant hand only; G3, none) during phase 1 (P1): R0–R2, phase 2 (P2): R3–R62, phase 3 (P3): R63–R65, phase 4 (P4): none, and phase 5 (P5): R66–R68. The scores were plotted and group learning curves were calculated. In all groups, the two-phase exponential decay model was the best fitting model

Fig. 3

Laparoscopic intra-corporeal knot tying (LICK). Individual learning curves. Participants of G1, G2, and G3 performed 69 consecutive repetitions (R0–R68) of the task. The scores were plotted and individual learning curves were observed, fitting to one- or two-phase exponential decay model according to participants’ performance

Fig. 4

Group laparoscopic intra-corporeal knot tying (LICK) learning curves. Participants of G1, G2, and G3 performed 69 consecutive repetitions (R0–R68) of the task during phase 1 (P1): R0–R2, phase 2 (P2): none, phase 3 (P3): R3–R62, phase 4 (P4): R63–R 65, and phase 5 (P5): R66–R68. The scores were plotted, and group learning curves were calculated. In all groups, the two-phase exponential decay model was the best fitting model