Intraoperative Verbal Communication in Pediatric Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure: A Comprehensive Analysis and Educational Implications.

INTRODUCTION

In pediatric surgery, declining case volumes and restrictions on working hours have intensified the need for efficient training strategies. The operating room remains a central educational environment, yet the nature of intraoperative teaching is unclear. We examined the educational role of intraoperative verbal communication and identified opportunities for improvement.

METHODS

We retrospectively analyzed data of unilateral single-incision laparoscopic percutaneous extraperitoneal closure procedures performed between December 2024 and June 2025 with complete audio and video recordings. Verbal statements were transcribed verbatim, classified by type and content, and analyzed for overall distribution, phase-specific frequency, composition of attending-to-operating surgeon communication, and intraoperative debriefing occurrence during the wound closure.

RESULTS

Nineteen cases were included, yielding 7374 statements. The most common content category was General (39.6%), followed by Instrument handling (19.1%), Anatomy (14.9%), and Operation method (14.8%). The proportion for Instrument handling increased to 27.1% during laparoscopic manipulation; that for Private talk rose to 18.5% during wound closure. Communication from attending to operating surgeons was most frequent in the laparoscopic manipulation phase (median, 3.4; interquartile range, 2.6-4.7, per minute), with higher proportions of Commanding (11.8%) and Advising (14.9%) statements. Intraoperative debriefing on the preceding laparoscopic phase occurred in only two cases (10.5%).

CONCLUSION

Intraoperative communication during single-incision laparoscopic percutaneous extraperitoneal closure demonstrates distinct phase-specific patterns, with heightened directive teaching during the laparoscopic manipulation phase but infrequent reflective debriefing. These findings suggest that systematically incorporating debriefing into the wound closure phase could foster reflective learning, complement real-time coaching, and enhance the overall educational impact of intraoperative experiences.