Laparoscopic training methods evolve, improve

February 1, 2005

Mumbai, India--Since the introduction of laparoscopic surgery to urology in the early 1990s, academic and community urology programs alike have been striving to learn and advance the specialized skills required to perform laparoscopic urologic surgery. At the 22nd World Congress on Endourology, an extensive session was de-voted to reporting the recent advances made in the field of laparoscopic training.

In one study, researchers showed that practicing U.S. urologists participating in a laparoscopy "mini-residency" improve some, but not all, laparoscopic skills following a week-long training course. In separate research on resident training, researchers found that the use of preoperative reading about a laparoscopic procedure improved decision-making skills but was not enough to improve laparoscopic judgment.

Learning after residency At the postgraduate level, practicing urologists have used several sources to learn how to perform laparoscopic surgery, in-cluding operating with the assistance of a colleague trained in laparoscopy and taking brief sabbaticals to work with surgeons proficient in laparoscopic techniques. Especially since the advent of robot-assisted laparoscopic surgery, academic-based "mini-residency" programs have emerged.

Dr. McDougall and Dr. Clayman evaluated the skills testing results and post-program surveys of the first 57 urologists who participated in the program. They found that trainees significantly improved their ability to thread a suture through loops (p<.05). However, trainees showed no statistically significant improvement in their ability to perform ring transfer, suturing, and form cutting. Based on the findings, the trainers have subsequently changed the course to include a daily 30-minute suturing and knot-tying practice session.

Trainees included a broad range of urologists, with 37.5% from small or solo practices, 37% from six- to 10-urologist practices, and 25% from academic programs. Less than two-thirds (62.5%) had prior laparoscopic training, and 87% had taken previous laparoscopic training courses. On average, trainees were 15.9 years out of residency.

Federico A. Corica, MD, a laparoscopy and endourology fellow at UC-Irvine who presented the group's results in Mumbai, said the response to the program has been excellent.

"[Straight laparoscopy] is very difficult to learn," Dr. Corica said. "However, a lot of these people were doing standard lap-aroscopy before the mini-residency. As such, after the mini-residency, they went on to do more challenging cases in their clinical practice."

The UC-Irvine robot-assisted lap-aroscopy "mini-residency" was designed to encourage urologists already familiar with laparoscopy to incorporate robotic surgery into their practices.