Formidable challenges to teaching advanced laparoscopic skills

Abstract

Despite the acceptance of laparoscopy for performing routine operations, a need still exists for experienced surgeons and surgical residents to maintain and refine essential surgical skills. Unless used on a frequent basis, laparoscopic skills are not easily maintained. In addition, when new laparoscopic instruments are introduced, surgeons need a way to practice using them that does not involve immediate patient contact. Novice surgeons need the most training of all and ideally would be best served using a standardized teaching curriculum that would cover as many of the basic laparoscopic parameters as possible. This article discusses how best to set up a laparoscopic simulation training program that covers as much ground as necessary, while respecting the restraints of time limitations and monetary concerns.

Figure 1.

Travel around a fixed point C. Arc distance AA' is greater than BB'.

Figure 2.

Mathematical representation of important laparoscopic angles and planes. α: Tissue angle, β: Instrument angle, TP: Tissue plane, IP: Instrument plane, S: tubular specimen, a: diaphragm, b: instrument shaft, c: entry port, d: abdominal wall, e: pelvic side wall, X: patient horizontal axis, Y: patient vertical axis.

Figure 3.

Representation of several tissue angles along the abdominal cavity.

Figure 4.

Specimen orientation at tissue angle a. A: horizontal, b: vertical c: oblique. X: patient horizontal axis, Y: patient vertical axis, Z: 3rd dimensional axis perpendicular to X & Y.