ASE ATLAS Database

Advanced Training in Laparoscopic Suturing

About

Rationale/Needs Assessment

Despite the evolution of multiple simulation-based training programs, it has remained difficult to teach advanced laparoscopic suturing.  In fact, on a national survey, 73% of Fellowship Council program directors and fellows reported a need for an advanced laparoscopic suturing curriculum. Several years ago, the Simulation Committee of the Association for Surgical Education (ASE) began to explore methods to address this gap. Content experts determined various skills requisite for advanced laparoscopic suturing and over two years refined tasks designed to teach and assess these skills. Ultimately, the Advanced Training in Laparoscopic Suturing (ATLAS) program was launched by the ASE in 2022 to offer a structured curriculum designed specifically for advanced laparoscopic suturing.

ATLAS is a proficiency-based curriculum consisting of six tasks:

  1. Needle handling
  2. Off-set camera forehand suturing
  3. Off-set camera backhand suturing
  4. Confined space suturing
  5. Suturing under tension
  6. Continuous suturing

The ATLAS curriculum has accumulated validity evidence to support broad scale adoption.  Numerous studies have documented the ability of scoring to distinguish surgeons of varying experience levels, improvements in surgeon performance following training, transferability to operative performance, and improved skill acquisition compared to other existing curricula.   

The ATLAS task set includes the trainer box, camera, models and supplies and can be ordered from Limbs and Things.  This website provides a curriculum guide with detailed instructions for set up and usage, as well as instructional videos. 

References:

  • Nepomnayshy, D., Whitledge, J., Birkett, R., Delmonico, T., Ruthazer, R., Sillin, L., & Seymour, N. E. (2014). Evaluation of advanced laparoscopic skills tasks for validity evidence. Surgical Endoscopy, 29(2), 349–354. https://doi.org/10.1007/s00464-014-3674-8
  • Nepomnayshy, D., Alseidi, A. A., Fitzgibbons, S. C., & Stefanidis, D. (2016). Identifying the need for and content of an advanced laparoscopic skills curriculum: Results of a national survey. The American Journal of Surgery, 211(2), 421–425. https://doi.org/10.1016/j.amjsurg.2015.10.009
  • Bilgic, E., Watanabe, Y., Nepomnayshy, D., Gardner, A., Fitzgibbons, S., Ghaderi, I., Alseidi, A., Stefanidis, D., Paige, J., Seymour, N., McKendy, K. M., Birkett, R., Whitledge, J., Kane, E., Anton, N. E., & Vassiliou, M. C. (2017). Multicenter proficiency benchmarks for advanced laparoscopic suturing tasks. The American Journal of Surgery, 213(2), 217–221. https://doi.org/10.1016/j.amjsurg.2016.07.033
  • McKendy, K. M., Watanabe, Y., Bilgic, E., Enani, G., Munshi, A., Lee, L., Feldman, L. S., Fried, G. M., & Vassiliou, M. C. (2017). Establishing meaningful benchmarks: The development of a formative feedback tool for advanced laparoscopic suturing. Surgical Endoscopy, 31(12), 5057–5065. https://doi.org/10.1007/s00464-017-5569-y
  • Enani, G., Watanabe, Y., McKendy, K. M., Bilgic, E., Feldman, L. S., Fried, G. M., & Vassiliou, M. C. (2017). What are the Training gaps for Acquiring Laparoscopic Suturing skills? Journal of Surgical Education, 74(4), 656–662. https://doi.org/10.1016/j.jsurg.2016.12.004
  • Watanabe, Y., McKendy, K. M., Bilgic, E., Enani, G., Madani, A., Munshi, A., Feldman, L. S., Fried, G. M., & Vassiliou, M. C. (2015). New models for advanced laparoscopic suturing: Taking it to the next level. Surgical Endoscopy, 30(2), 581–587. https://doi.org/10.1007/s00464-015-4242-6
  • Nepomnayshy, D., Whitledge, J., Fitzgibbons, S., Nijjar, B., Gardner, A., Alseidi, A., Birkett, R., Deal, S., Duvra, R. R., Anton, N., & Stefanidis, D. (2019). Advanced laparoscopic skills: Understanding the relationship between simulation-based practice and clinical performance. The American Journal of Surgery, 218(3), 527–532. https://doi.org/10.1016/j.amjsurg.2019.01.024
  • Gabrysz-Forget, F., Bonds, M., Lovett, M., Alseidi, A., Ghaderi, I., & Nepomnayshy, D. (2020). Practicing on the advanced training in Laparoscopic Suturing Curriculum (ATLAS): Is mastery learning in Residency feasible to Achieve expert-level performance IN Laparoscopic Suturing? Journal of Surgical Education, 77(5), 1138–1145. https://doi.org/10.1016/j.jsurg.2020.02.026
  • Athanasiadis, D. I., Anton, N. E., Karim, A., Colgate, C. L., & Stefanidis, D. (2021). Does the advanced training in laparoscopic suturing enhance laparoscopic suturing skill beyond fundamentals of laparoscopic surgery? Surgery. https://doi.org/10.1016/j.surg.2021.06.041