Role of Endotrainers in Laparoscopic Surgical Training of Young Surgeons

Background: Laparoscopic surgery is the preferred technique for many surgical procedures due to its minimal invasiveness and faster recovery, but effective training remains a challenge, especially in low-resource settings lacking formal simulation tools. There is a significant need to evaluate cost-effective alternatives, such as homemade endotrainers, to bridge the skill acquisition gap among surgical trainees. Objective: To assess the effectiveness of low-cost endotrainers in improving the laparoscopic skills—specifically peg transfer, ligating endoloop, intracorporeal knotting, and extracorporeal knotting—among postgraduate general surgical trainees over a one-month training period. Methods: This was a prospective observational study conducted at Lahore General Hospital with a sample of 30 third- and fourth-year general surgery residents. Inclusion criteria were residency status and willingness to participate; exclusion criteria included prior advanced laparoscopic training. Performance was assessed pre- and post-training using timed skill tasks and failure rates, evaluated by blinded laparoscopic surgeons. Ethical approval was granted by the Institutional Review Board, with all procedures adhering to the Helsinki Declaration. Data were analyzed using SPSS v27, employing paired sample t-tests and McNemar’s test to assess improvements. Results: Statistically significant improvements were observed in mean task times: peg transfer (10.87 to 2.57 min, p=0.012), endoloop (12.75 to 7.50 min, p=0.015), intracorporeal knotting (7.13 to 2.10 min, p=0.049), and extracorporeal knotting (11.67 to 3.33 min, p=0.015). Task failure rates also declined notably. Clinically, trainees demonstrated enhanced coordination, efficiency, and safety. Conclusion: Cost-effective, homemade endotrainers significantly improve basic laparoscopic skills among surgical residents, supporting their integration into surgical training, especially in resource-limited environments to enhance procedural safety and patient outcomes.