Introduction Minimally invasive surgery skill laboratories are indispensable in training, especially for complex procedural skills such as intracorporal suturing and knot tying (ICKT). However, maintaining a laboratory is expensive, and specially trained teachers are in short supply. During the COVID-19 pandemic, in-person instruction has reduced to almost zero, while model learning via video instruction (VID) has become an integral part of medical education. The aim of this study was to compare the learning effectiveness and efficiency of ICKT by laparoscopically inexperienced medical students through video versus direct expert instruction.

Materials and Methods A secondary analysis of two randomized controlled trials was performed. We drew data from students who were trained in ICKT with expert instruction (EXP, n = 30) and from students who were trained via VID, n = 30). A laparoscopic box trainer including laparoscope was used for ICKT. Objective Structured Assessment of Technical Skills (OSATS), knot quality, and total ICKT time were the parameters for the assessment in this study. Proficiency criteria were also defined for these parameters.

Results Students in the EXP group performed significantly better in OSATS-procedure-specific checklist (PSC) and knot quality compared with students in the VID group, with no difference in task time. Of the students who reached the proficiency criteria for OSATS-PSC and knot quality, those in the EXP group required fewer attempts to do so than those in the VID group. Students in both groups improved significantly in all parameters over the first hour of evaluation.

Conclusion For the laparoscopically inexperienced, training in ICKT through expert instruction presents an advantage compared with video-based self-study in the form of faster understanding of the procedure and the associated consistent implementation of good knot quality. Both teaching methods significantly improved participants' ICKT skills.

简介 微创手术技能实验室在培训中不可或缺，特别是对于复杂的程序技能，如体内缝合和打结 (ICKT)。然而，维护一个实验室是昂贵的，而且受过专门训练的教师供不应求。在 COVID-19 大流行期间，面对面教学几乎减少到零，而通过视频教学 (VID) 进行的模型学习已成为医学教育不可或缺的一部分。本研究的目的是比较没有腹腔镜经验的医学生通过视频与直接专家指导的 ICKT 学习效果和效率。

材料和方法 对两项随机对照试验进行了二次分析。我们从接受专家指导的 ICKT 培训的学生（EXP，n  = 30）和通过 VID 培训的学生，n  = 30）中提取数据。包括腹腔镜在内的腹腔镜盒式训练器用于 ICKT。技术技能的客观结构化评估 (OSATS)、结质量和 ICKT 总时间是本研究中评估的参数。还为这些参数定义了熟练程度标准。

结果 与 VID 组学生相比，EXP 组学生在 OSATS 程序特定检查表 (PSC) 和结质量方面的表现明显更好，任务时间没有差异。在达到 OSATS-PSC 和结质量熟练标准的学生中，EXP 组的学生比 VID 组的学生需要更少的尝试。在第一个小时的评估中，两组学生的所有参数都有显着提高。

结论 对于腹腔镜经验不足的患者，通过专家指导进行 ICKT 培训与基于视频的自学相比具有优势，可以更快地理解程序和相关的一致实施良好的结质量。两种教学方法都显着提高了参与者的 ICKT 技能。