Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil?

Background: For all surgical procedures, a surgeons' learning curve can be anticipated during which complication rates are increased. The aims of this study were to evaluate individual learning curves for a group of surgeons performing laparoscopic fundoplication and to evaluate if the Procedicus MIST-simulator (Mentice Inc., Goteborg, Sweden) accurately predicts surgical performance. Methods: Twelve. Nordic centers participated, each contributing with a "master" and a "pupil" surgeon. The pupils were tested in the simulator and thereafter performed their first 20 supervised operations. All procedures were videotaped and evaluated by 3 independent reviewers. Results: A significant decrease in operative time (P < 0.001) and a trend (P = 0.12) toward improved score were seen during the series. The master significantly affected the pupil's score (P = 0.0137). The simulator-test showed no correlation with the operative score. Conclusions: Individual learning curves varied, and the teacher was shown to be the most important factor influencing the pupil's performance score. The correlation between assessed performance and patient outcome will be further investigated. (C) 2005 Excerpta Medica Inc. All rights reserved.