Simulation-based training and learning curves in laparoscopic Roux-en-Y gastric bypass

Br J Surg. 2012 Jul;99(7):887-95. doi: 10.1002/bjs.8748. Epub 2012 Apr 18.


Background: Ex vivo simulation-based technical skills training has been shown to improve operating room performance and shorten learning curves for basic laparoscopic procedures. The application of such training for laparoscopic Roux-en-Y gastric bypass (LRYGBP) has not been reviewed.

Methods: Relevant studies were identified by one author from a search of MEDLINE and Embase databases from 1 January 1994 to 30 November 2010. Studies examining the learning curves and ex vivo training methods for LRYGBP were included; all other types of bariatric operations were excluded. A manual search of the references was also performed to identify additional potentially relevant papers.

Results: Twelve studies (5 prospective and 7 retrospective case series) were selected for review. The learning curve for LRYGBP was reported to be 50-100 procedures. Bench-top laparoscopic jejunojejunostomy, anaesthetized animals and Thiel human cadavers made up the bulk of the reported models for ex vivo training. Most studies were of relatively poor quality. An evidence-based ex vivo training curriculum for LRYGBP is currently lacking.

Conclusion: Better quality studies are needed to define the learning curve for LRYGBP. Future studies should focus on the design and validation of training models, and a comprehensive curriculum for training and assessment of cognitive, technical and non-technical components of competency for laparoscopic bariatric surgery.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Cadaver
  • Clinical Competence / standards
  • Computer Simulation
  • Education, Medical, Graduate / methods*
  • Gastric Bypass / education*
  • Gastric Bypass / standards
  • Gastric Bypass / statistics & numerical data
  • General Surgery / education*
  • Humans
  • Laparoscopy / education*
  • Laparoscopy / standards
  • Laparoscopy / statistics & numerical data
  • Learning Curve*
  • Length of Stay
  • Models, Animal
  • Postoperative Complications / etiology
  • Prospective Studies
  • Retrospective Studies
  • Teaching / methods