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Background: During COVID-19 pandemic, many restrictions were applied in the field of health care. For this reason, we decided to adopt the laparoscopic simulator Laparo® Analytic to allow the trainees of our pediatric surgery training program to continue their training activity, and we determined its impact on their surgical education. Methods: We used Laparo Analytic Simulator for laparoscopic surgery training among the residents of our center. Fifteen residents from different years of the pediatric surgery program participated in this study. Each participant performed a 2-hour training session per week, consisting of three different exercises: Rubber Bands, Knotting, and Suturing. For each training session, the following parameters were analyzed: training time, economy of movement, smoothness, instrument activity (IA), instrument visibility (IV), and instrument symmetry. Results: Results were collected after the first training session (T0), at 3 months after the beginning of the study (T1) and at 6 months after the beginning of the study (T2). At T2 of training with Laparo Analytic Simulator, residents were able to complete their tasks significantly faster (P = .001) and had a significant improvement in smoothness of movements, IA, IV, and instrument symmetric movements during the tasks analyzed. Conclusion: On the basis of our results, we believe that Laparo analytic is an excellent system to adopt in minimally invasive surgery (MIS) training programs, in particular, during periods of surgical restrictions, as COVID-19 pandemic, or in centers with a limited MIS activity.

Introduction: Three-dimensional (3D), high-definition (HD), and ultra-high-definition (4K HD) are recent additions over regular HD technology for laparoscopic surgery. The aim of this study was to ...

Background: The eoSim® laparoscopic augmented reality (AR) simulator has instrument tracking capabilities that may be suitable for implementation in laparoscopic training. The objective is...

Laparoscopy is used increasingly to treat malignant and benign colorectal surgical diseases. However, this practice is still not offered to all patients. Many barriers halt the widespread use of laparoscopic colorectal surgery. Both surgeon's and patient's factors contribute to limit a wider use of laparoscopy in colorectal surgery.We retrospectively analyzed 408 consecutive colorectal resections in a 4-year period, to find out if a selection bias exists in using laparotomy or laparoscopy for colorectal surgical diseases, and which factors are associated with a poor use of laparoscopy or to a preferred laparotomy.In our practice, advanced disease, American Society of Anesthesiologist class III and IV, and emergency status are all patient-related factors associated with laparotomy. Surgeon's age more than 52 years and lack of laparoscopic training are surgeon-related factors that negatively affect the chance of being operated on with the laparoscopic technique.An extensive laparoscopic colorectal training and a supporting environment, especially during the night shift, are needed to facilitate the use of laparoscopy in colorectal surgery avoiding a bias in selecting surgical candidates to one technique or another.

To show the benefit of three-dimensional (3D) reconstructions of preoperative imaging for surgical performance.A laparoscopic training environment with 15 hidden lymph nodes was designed. Three of them were marked with radiographic contrast agent and were only distinguishable from unmarked nodes via CT imaging. Thirty-six surgeons were divided into two groups. To group 1 the unprocessed CT data were shown. Group 2 was additionally shown a 3D reconstruction of the anatomy. Time of studying the imaging was recorded. All surgeons had to find the three target lymph nodes laparoscopically. Time to fulfill this task and errors was measured. Afterward, the 3D reconstruction was also shown to group 1. Then, all participants completed a questionnaire. Furthermore, 3D reconstructions were used in 15 clinical cases of partial nephrectomy or lymphadenectomy, and surgeons' opinion was evaluated with an additional questionnaire. The imaging and 3D reconstructions were available on a mobile device.The time of studying the imaging to gain confidence was significantly shorter with the 3D reconstruction. Laparoscopic intervention time was shortened and errors were reduced significantly within group 2. The clinical application of 3D reconstructions in difficult cases was believed to be helpful.3D reconstructions of preoperative imaging lead to better surgical performance in a difficult laparoscopic training environment. Surgeons gain a 3D impression of patients' individual anatomy easier, faster, and more reliable. Providing 3D reconstructions previous to surgery should be routinely implemented for patients with complex anatomical situations.

Various methods for evaluating laparoscopic skill have been reported, but without detailed information on the configuration used they are difficult to reproduce. Here we present a method based on the trigonometric relationships between the instruments used in a laparoscopic training platform in order to provide a tool to aid in the reproducible assessment of surgical laparoscopic technique.The positions of the instruments were represented using triangles. Basic trigonometry was used to objectively establish the distances among the working ports RL, the placement of the optical port h', and the placement of the surgical target OT.The optimal configuration of a training platform depends on the selected working angles, the intracorporeal/extracorporeal lengths of the instrument, and the depth of the surgical target. We demonstrate that some distances, angles, and positions of the instruments are inappropriate for satisfactory laparoscopy.By applying basic trigonometric principles we can determine the ideal placement of the working ports and the optics in a simple, precise, and objective way. In addition, because the method is based on parameters known to be important in both the performance and quantitative quality of laparoscopy, the results are generalizable to different training platforms and types of laparoscopic surgery.

Robotic surgical technology has been adopted by surgeons with and without previous standard laparoscopic experience. The necessity or benefit of prior training and experience in laparoscopic surgery is unknown. We hypothesized that laparoscopic training enhances performance in robotic surgery.Fourteen medical students with no surgical experience were instructed to incise a spiral using the da Vinci(®) surgical robot with time to completion and errors recorded. Each student was then trained for 1 month in standard laparoscopy, but with no further robotic exposure. Training included a validated laparoscopic training program, including timed and scored parameters. After completion of the month-long training, the students repeated the cutting exercise using the da Vinci robot as well as with standard laparoscopic instruments and were scored within the same parameters.The mean time to completely incise the spiral robotically before training was 16.72 min with a mean of 6.21 errors. After 1 month of validated laparoscopic training, the mean robotic time fell to 9:03 min (p=0.0002) with 3.57 errors (p=0.02). Laparoscopic performance after 1 month of validated laparoscopic training was 13.95 min with 6.14 errors, which was no better than pretraining robotic performance (p=0.20) and worse than post-training robotic performance (p=0.01).Formal laparoscopic training improved the performance of a complex robotic task. The initial robotic performance without any robotic or laparoscopic training was equivalent to standard laparoscopic performance after extensive training. Additionally, after laparoscopic training, the robot allowed significantly superior speed and precision of the task. Laparoscopic training may improve the proficiency in operation of the robot. This may explain the perceived ease with which robotics is adopted by laparoscopically trained surgeons and may be important in training future robotic surgeons.

Purpose: We describe an extended training program using the pelvitrainer to improve the basic laparoscopic skills of the junior urologists.Ten junior residents were involved in our program that consisted of an hour of training every other day; every 3 hours represented one training session. This curriculum started with 4 inanimate tasks that included peg transfer, disc cutout, extracorporeal, and intracorporeal knot tying. Each task was practiced for one training session with an objective evaluation at the initial attempt and at the end of its session. Thereafter, the participants began to perform an anastomosis using a latex glove model of the laparoscopic urethrovesical anastmosis (L-UVA) (5 experiments). This was followed by 10 experiments of the sheep intestine model of the L-UVA. The performance in these models was evaluated by both the amount of leakage of the injected saline and the time required for completing it. Lastly, another sheep intestine model was performed 3 weeks after the end of the training program.The continuous evaluation of these trainees showed that there was a significant decrease in the time required to perform each of the first 4 tasks at the end of their corresponding sessions compared to the base line values (p=0.000). We also detected a significant decrease in the time and the amount of leakage in sheep intestine models in the 10th attempt compared to the first one (p=0.000). However, there was no significant difference between the results at the 10th model and those of the 3 weeks retest regarding both the time (p=0.198) and the amount of leakage (p=0.076).The use of the two described models of the L-UVA after the inanimate tasks in the pelvitrainer distributed course of training could help in the improvement and in the retention of the basic laparoscopic skills of the junior urologists.

To evaluate the feasibility of intensive laparoscopic training shortening the learning curve of laparoscopic suturing in surgical postgraduate students.Eighty-seven surgical postgraduate students participated in this study, including novice (N), junior (JR), and senior (SR) trainees. The N trainees were divided into novice control (NC) and novice experimental (NE) groups. The training curricula contain three stages: Fundamentals of laparoscopic surgery tasks, intensive laparoscopic suturing task, and laparoscopic enucleation model training. The NE, JR, and SR groups completed all three stages. The NC group just performed the first and third stages. The performances of each group were recorded and analyzed.For the first stage, the SR group performed better than the N and JR groups. There was no significant difference in the post-test total scores between the N and JR groups, although the N group had lower pretest total scores. For the second stage, no significant difference was found in the post-test scores among the NE, JR, and SR groups, although the SR group had better pretest scores. For the third stage, the NE, JR, and SR groups had better performance than the NC group at the five exercises. There was no significant difference at the fifth exercise among the NE, JR, and SR groups, although the SR group performed better at the former four exercises.This study documented the feasibility of intensive laparoscopic training curricula shortening the learning curve of laparoscopic suturing in surgical postgraduate students, regardless of baseline experience.

Aim: To provide an evidence-based analysis on the status and perspectives of laparoscopic training in urologic surgery. Methods: A thorough review of the current literature was performed as of January 31, 2009, using the Medline database through a PubMed search. The search protocol included a free-text query using the following terms: "training,'' "urologic laparoscopy,'' "urology,'' and "laparoscopy.'' Suitable articles were selected on the basis of the study content. The following issues were addressed: prediction of laparoscopic skills and transfer of training in clinical practice; homemade and commercially available laparoscopic trainers and simulators; training models for specific laparoscopic procedures; mentored training programs; formal training programs; and the impact of robotics in laparoscopic training. Results: Currently available tools predicting laparoscopic skills lack adequate validation to justify their widespread adoption. There still is not enough evidence to show definite transfer of skills from currently available simulators to the operating theater. Learning opportunities continue to evolve. Specific models have been developed for complex procedures. Various informal training programs exist, yet most urologists will not be able to complete a formal fellowship. Postgraduate urologists may possibly be more rapidly and efficiently trained using a structured mentoring program. Robotics is likely to have an increasing role in teaching urological laparoscopy. Conclusions: Despite progress in recent years and an extensive amount of data from the urological literature, the ideal training program in urological laparoscopy remains a goal to be determined objectively

Laparoscopic surgery has become the standard of care for many surgical diseases. Haptic (tactile) feedback (HFB) is considered an important component of laparoscopic surgery. Virtual reality simulation (VRS) is an alternative method to teach surgical skills to surgeons in training. Newer VRS trainers such as the Simbionix Lap Mentor II provide significantly improved tactile feedback. However, VRSs are expensive and adding HFB software adds an estimated cost of $30,000 to the commercial price. The HFB provided by the Lap Mentor II has not been validated by an independent party. We used the Simbionix Lap Mentor II in this study to demonstrate the effect of adding an HFB mechanism in the VRS trainer.The study was approved by the University of Cincinnati Institutional Review Board. Twenty laparoscopically novice medical students were enrolled. Each student was asked to perform three different tasks on the Lap Mentor II and repeat each one five times. The chosen tasks demanded significant amount of traction and counter traction. The first task was to pull leaking tubes enough and clip them. The second task was stretching a jelly plate enough to see its attachments to the floor and cut these attachments. In the third task, the trainee had to separate the gallbladder from its bed on the liver. The students were randomized into two groups to perform the tasks with and without HFB. We used accuracy, speed, and economy of movement as scales to compare the performance between the two groups. The participants also completed a simple questionnaire that highlighted age, sex, and experiences in videogame usage.The two groups were comparable in age, sex, and videogame playing. No differences in the accuracy, the economy, and the speed of hand movement were noticed. In fact, adding HFB to the Lap Mentor II simulator did not contribute to any improvement in the performance of the trainees. Interestingly, we found that videogame expert players tend to have faster and more economic motion in their dominant hands. However, the performance accuracy was not significantly affected.The presence of HFB has less effect than it thought to be on the performance of the novice trainees. This may suggest that better HFB is still needed. However, there may be visual compensation for the lack of haptics. Playing videogames has a positive impact on economy, and the speed of the dominant had motion without affecting its accuracy. Further research is needed to clarify the value of haptics to the expert surgeon and compare it to the new trainees.

To create and evaluate the effectiveness of an in vitro training model for laparoscopic urethrovesical anastomosis.Chicken posterior trunks and porcine colons were used to construct the training model, which was later compared with the chicken skin model. The posterior trunk of a chicken was used to simulate a human pelvis, and a 3-mm cloacal stump was used to simulate a human urethral stump. A 15-cm segment of porcine colon with a 1-cm orifice was used to simulate a human bladder or neobladder. An imitation urethrovesical anastomosis was performed with laparoscopic instruments in a laparoscopic training box. The simulated urethral stump and bladder neck were anastomosed with six interrupted stitches. Forty urologic residents were randomized into two groups. The residents in group A (n = 20) practiced using this model for 8 hours, while those in group B (n = 20) practiced using the chicken skin model for 8 hours. The residents' skills were assessed using the porcine model before and after training.All residents accomplished the training course and both assessments. There was no significant difference between the groups in anastomosis time (122.65 +/- 19.98 minutes v 120.70 +/- 17.30 minutes, P0.05) and quality (3.80 +/- 1.24 v 3.75 +/- 1.16, P0.05) before training. After the training sessions, both groups improved in anastomosis time and quality. Compared with residents in group B, residents in group A required less time (63.55 +/- 11.08 minutes v 76.55 +/- 12.46 minutes, P0.05) and achieved a higher quality score (8.80 +/- 1.00 v 7.65 +/- 0.88, P0.05).This training model more accurately resembles the structure and characteristic of the human pelvis, urethral stump, and bladder (neobladder). In addition, all the materials needed for this model are inexpensive and easily obtained. Therefore, it is an effective, convenient training model for laparoscopic urethrovesical anastomosis.

This study aimed to evaluate whether laparoscopic appendectomy is suitable for training residents to become proficient in laparoscopic surgery.A total of 1574 laparoscopic appendectomies were performed at En-Chu-Kong Hospital between January 1998 and December 2003 (788 men and 786 women). These cases were divided into three groups: 543 cases (in 1998-1999) performed by 5 attending surgeons during the learning and trial stage; 536 cases (in 2000-2001) performed by 5 attending surgeons assisted by 2 senior residents with prior experience in open appendectomy; and 495 cases (in 2002-2003) done by these 2 senior residents, supervised by the attending surgeons. Demographic data, intraoperative findings, operative time, conversion rate, frequency of analgesic injection, timing of oral intake, hospital stay, morbidity, and mortality were analyzed.There were no statistically significant differences in the operations performed by attending surgeons (mature stage) vs. senior residents in terms of intraoperative findings, operative time (60.1 +/- 60.4 minutes vs. 56.3 +/- 25.6 minutes), conversion rate (1.12% vs. 0.81%), frequency of analgesic injection (0.57 +/- 1.37 times/stay vs. 0.43 +/- 0.94 times/stay), timing of oral intake (23.7 +/- 30.2 hours vs. 20.8 +/- 27.5 hours), hospital stay (73.9 +/- 61.8 hours vs. 70.3 +/- 51.6 hours), morbidity, or mortality (0% vs. 0.2%).Laparoscopic appendectomy can be safely incorporated into the training of surgical residents under the supervision of experienced surgeons. Laparoscopic appendectomy also provides knowledge of the basics of laparoscopic technique before going on to more complex operations.

Laparoscopic urologic surgery is not widely practiced in South Africa. After presenting a laparoscopic training course, we evaluated how effectively this training translated into clinical practice.Invitations to the course were sent to all South African urologists. Ten applicants attended the course, which consisted of dry and in-vivo animal surgery. Two questionnaires were sent out after the course. Questionnaire 1 (at course completion) aimed at identifying the precourse laparoscopic experience and expectations of the trainee. Questionnaire 2 (6 months postcourse) assessed how much laparoscopic surgery the participant had performed since the course.Seventeen percent of all South African urologists responded to the invitation. Prior to the course, 40% of trainees had performedor=10 laparoscopic cases, 30% had performed10 cases, and 30% had never performed laparoscopy, whereas 60% expected to be doing one or two cases a month after completing the course. Six months after the course, 60% had performed no laparoscopic cases. Of the three trainees who had never before done laparoscopic procedures, none had started to perform procedures since the course. The commonest procedures performed were varicocelectomy and diagnostic laparoscopy for nonpalpable testis.A hands-on laparoscopic training course to introduce laparoscopic urology into South African private urology practice has not translated into a satisfactory number of clinical cases being performed. The causes are likely multifactorial but are greatly influenced by social and economic forces. One possible solution may be to offer a mentor-based training program.

We investigated the impact of robotics on surgical skills by comparing traditional laparoscopy with the da Vinci Surgical System in the performance of various laparoscopic training drills.Twenty-one surgeons performed eight timed drills of increasing difficulty with a laparoscopic trainer and the da Vinci Surgical System (Intuitive Surgical Sunnyvale, CA). The mean time to drill completion, drill time variance, and statistical analysis were performed. Surgeons were also questioned about their perception of the robotic technology following completion of the drill series.The mean time required to complete the first drill was 69 seconds with laparoscopy and 57 seconds with the robotic system. The mean times for drill two were 67 seconds with laparoscopy and 44 seconds with robotics; for drill three, the times were 88 seconds for laparoscopy and 61 seconds for robotics, and for drill four, 186 seconds with laparoscopy and 71 seconds with robotics. Only the first drill failed to show a statistically significant difference between the laparoscopic and robotic groups.The robotic system allowed surgeons to complete drills faster than traditional laparoscopy. Novice laparoscopic surgeons performed three of the four drills faster robotically than did expert laparoscopic surgeons. These findings may indicate that the attributes of the robotic system level the playing field between surgeons of different skill levels. The next generation of surgeons must focus on this evolving technology and its application in the operating room of the future.

Laparoscopic training has been incorporated into many urology residency programs. Although the impact of laparoscopic training courses has been examined, the impact of residency training in laparoscopy on subsequent urology practice patterns has not been assessed.Urologists completing their residency from 1977 through 1999 at Tulane University and the University of California-San Diego were sent anonymous questionnaires in September 2000. The questionnaires evaluated practice demographics, operative experience in laparoscopy during residency, and the role of laparoscopy in the urologist's current practice. Factors impacting the decision to perform or not perform laparoscopy were evaluated.Sixty-one former residents (67%) responded to the questionnaire. Urologists were more likely to perform laparoscopic procedures if they had been trained during their residency (69%) than if they had no experience during residency (34%; p0.025). Intensity of laparoscopic experience in residency did not appear to correlate with ongoing practice, with 73% of residents having15 cases during residency training continuing to perform laparoscopy compared with 67% of residents doing 15 to 80 laparoscopic cases. Urologists who had been trained in laparoscopy during residency cited the need for more training (47%) and inadequate case volume (47%) as reasons for not currently performing laparoscopy. Among those who had received residency training, the most common reasons given were inadequate case volume (61%) and increased operative time (57%).This survey suggests that laparoscopic procedures are more likely to be performed by physicians who have received training during residency. As the number of urologists who have been trained in laparoscopy during residency increases, shifts in practice patterns will continue to evolve, along with advances in urologic laparoscopy.

Laparoscopic surgery is well known as having a long and variable learning curve. In fact, successive generations of surgeons were able to reduce their operative time and plateau their learning curves. This raises the question as to how early in medical education we can integrate laparoscopic skills. In this study, we are trying to demonstrate the effect of age on acquiring new laparoscopic skills.Thirty-two trainees at various educational levels and ages were recruited to our study. Trainees were divided into four age groups with eight persons in each group. Senior high school students, undergraduate college students, medical students, and junior surgery residents comprised the first, second, third, and the fourth groups, respectively. The trainees performed nine inanimate laparoscopic tasks in the laparoscopic training box and repeated each task five times. The time needed for each trial was recorded, and the results were statistically analyzed.The youngest group of trainees showed the largest improvement in performance time, followed by the second and third groups. The most senior group showed the least improvement.These preliminary data suggest that younger trainees are faster to acquire new laparoscopic skills than the older persons. This finding suggests a potential benefit from earlier integration of laparoscopic skills in medical education.

Hasson and Grimes have developed the so-called open laparoscopy technique. Patients with surgical history and obese patients present a higher risk for laparoscopy. Since the development of laparoscopic cholecystectomy general surgeons have been able to obtain instruction in percutaneous and open techniques in various laparoscopic training centers throughout the United States. The percutaneous technique uses the Veress needle, while the open technique uses the Hasson cannula. We present a modification of the open technique using a finger and rubber catheter to thread the trocar cannula into the abdomen using standard disposable cannulas and avoiding the use of the Hasson cannula.