It is evident that refined cognitive and surgical skills are necessary to remain proficient in urologic laparoscopy.
Yet, one may ask, "Why it is nearly 15 years since Ralph Clayman performed the first laparoscopic nephrectomy in St. Louis, and there is still a concern that laparoscopy is not fully incorporated into all residency programs worldwide?" I believe the reason remains that traditional laparoscopy is hard to do. Laparoscopic procedures require that the surgeon have specific skills and remain clinically active to maintain proficiency.
At the UC-Irvine teaching center, measures have been made to evaluate the value of a week-long multimodality preceptorship in laparoscopy, as discussed in this issue of Urology Times (see article). UT Southwestern researchers showed that sound laparoscopic urologists who improved their cognitive skills with preoperative reading improved their surgical performance more than less-experienced urologists who read preoperatively. Although more studies like these are needed, it is evident that refined cognitive and surgical skills are necessary to remain proficient in urologic laparoscopy.
The question remains, "How do we teach laparoscopy to all urologists who want to learn, and what do we teach them?" To a large extent, the practice pattern of laparoscopists at training programs will guide these trends, as most residencies are becoming proficient at teaching urologic laparoscopy.
My concern is that the use of hand-assistance and robotics, although clearly beneficial to all involved, may also limit the advancement of laparoscopy in urology. I believe the advancement of clinical urologic laparoscopy will require "slick" laparoscopic urologists who can do almost anything using traditional laparoscopic tools. So, I've decided I better keep my pelvic trainer.