Effectiveness of stepwise simulation training in the formation of laparoscopic surgical skills

Background. Minimally invasive surgery has become one of the most rapidly developing fields of modern medicine over the past two decades. Laparoscopic interventions are the method of choice in the treatment of many abdominal diseases due to reduced surgical trauma, less postoperative pain, shorter hospital stays, and faster patient recovery.

Objective – to evaluate the effectiveness of a stepwise simulation training model in developing practical skills in laparoscopic surgery and to determine its educational value for the training of specialists with different levels of professional experience.

Material and methods. A prospective interventional study was conducted at the Training and Simulation Center of Urgench State Medical Institute (Republic of Uzbekistan) in 2024–2025. The study included 265 trainees with varying levels of practical experience in laparoscopic surgery. Training was conducted in stages using three simulation platforms: a box trainer (iModels), an analytical simulator (LAPARO Analytic), and a high-fidelity simulation complex (LAPARO APEX). In the final stage, laparoscopic cholecystectomy, appendectomy, TAPP hernioplasty, fundoplication, and sleeve gastrectomy were simulated. Training effectiveness was assessed by task completion time, number of technical errors, manipulation accuracy, instrument trajectory, and the integral rating automatically calculated by the simulators. Statistical analysis was performed using parametric methods, with statistical significance set at p<0.05.

Results. Upon completion of the training program, all groups demonstrated significant improvement in practical performance. For trainees with no prior experience in laparoscopic interventions, task completion time decreased by 38.6%, and the number of technical errors dropped by 42.1% (p<0.001). Participants with intermediate training showed a 29–33% improvement in movement accuracy and performance efficiency in complex simulation scenarios (p<0.01). Trainees with initial independent laparoscopic practice demonstrated statistically significant improvement in movement coordination, dissection quality, and operative timing (p<0.05). The most pronounced improvement was observed in novice surgeons, confirming the high effectiveness of the sequential training model.

Conclusion. The stepwise simulation training model ensures the sequential development of the technical and cognitive competencies required for the safe performance of laparoscopic interventions. The consecutive use of a basic box trainer, an analytical platform, and a high-fidelity simulator allows for objective monitoring of skill acquisition and enhances the quality of surgical training. The results support the widespread implementation of this model in the educational process of medical universities, simulation centers, and postgraduate professional education systems.

1. Batirov D.Yu., Yangibaev Z., Rakhimov A.P., et al. Effectiveness of simulation-based training in lapa­ roscopic surgery: analysis of clinical experience. Preventive Medicine and Health. 2026; 5 (1): 343–9. DOI: https://doi.org/10.47689/2181-3663-vol5-iss1-pp343-349 (in Russ.)

2. Volkov V.G., Survillo E.V., Granatovich N.N., et al. The importance of simulation-based teaching methods in obstetrics and gynecology. International Research Journal. 2025; 155 (5). DOI: https://doi.org/10.60797/IRJ.2025.155.55 (in Russ.)

3. Orlov Yu.V., Mutigullina A.A. Simulation-based training technology as a new paradigm of modern medical education. Cardiovascular Therapy and Prevention. 2024; 23 (4S): 4315. https://doi.org/10.15829/1728-8800-2024-4315 (in Russ.)

4. Shabunin A.V., Klimakov A.V., Logvinov Yu.I., Maer R.Yu. Method for assessing the effectiveness of simulation-based training in laparoscopic intracorporeal suturing. Health of Megapolis. 2023; 4 (2): 15–29. DOI: https://doi.org/10.47619/2713-2617.zm.2023.v.4i2;15-29 (in Russ.)

5. Batirov D.Y., Rakhimov A.P., Rojobov R.R., et al. The role of simulation-based training in laparoscopic surgery. American Journal of Medicine and Medical Sciences. 2026; 16 (2): 430–2. DOI: https://doi.org/10.5923/j.ajmms.20261602.09

6. Celdrán F., Jiménez-Ruescas J., Lobato C., et al. Use of augmented reality for training assistance in laparoscopic surgery: scoping literature review. J Med Internet Res. 2025; 27: e58108. DOI: https://doi.org/10.2196/58108

7. Hashimoto D.A., Rosman G., Rus D., Meireles O.R. Artificial intelligence in surgery: promises and pe­ rils. Ann Surg. 2018; 268 (1): 70–6. DOI: https://doi.org/10.1097/SLA.0000000000002693

8. Tariq S., Cainelli F., Sahraoui A., Achar A. Extended reality in laparoscopic cholecystectomy training: a systematic review and meta-analysis. Journal of Surgical Research. 2025; 316: 143–55. DOI: https://doi.org/10.1016/j.jss.2025.06.056

9. Thomaschewski M., Vonthein R., Keck T., Laubert T., Benecke C.; NOVICE study group. Laparoscopic simulation training improves operating room performance of surgical residents: a multicenter randomized trial (NOVICE). International Journal of Surgery. 2025; 111 (4): 2923–32. DOI: https://doi.org/10.1097/JS9.0000000000002304