Laparoscopic Practice Research Articles

Validation of a Novel Inverted Peg Transfer Task: Advancing Beyond the Regular Peg Transfer Task for Surgical Simulation-Based Assessment

To evaluate the validity of a novel inverted peg transfer (iPT) task for assessing laparoscopic skills of novices and experts and compare iPT to the regular PT (rPT) task to ensure surgical trainee acquisition of an adequate advanced laparoscopic skills level for safe laparoscopic practice in the operating room. Prospective crossover study. Multidisciplinary simulation center and motion analysis laboratory, Mayo Clinic. Novices were medical students and surgical interns without laparoscopic experience. Experts were surgeons with at least 3 years of experience in laparoscopic surgery. This was the first exposure to iPT for both groups. Completion time and performance metrics were recorded. A scoring rubric was used to calculate a normalized performance score between 0 and 100. Wilcoxon rank sum and Mann-Whitney tests were performed with α = 0.05. Receiver-operating characteristic curves were graphed for the 2 task scores to assess the tasks' sensitivity and specificity in differentiating laparoscopic experience level. Performance measures of completion time, transferred triangles, dropped triangles (errors), and the overall performance score on both tasks between- and within-subjects (i.e., novices and experts). Thirty-six novices and eight experts participated. Both experts and novices had longer completion time and lower scores during iPT than rPT (p < 0.05). Within iPT, novice completion times were 144 seconds longer (p = 0.04), and performance score was 35 points lower than experts (p < 0.01). No differences between novices and experts were observed for completion time or performance scores (p > 0.05) for rPT. The iPT scores had a higher sensitivity and specificity than the rPT (area under the receiver-operating characteristic curve: iPT = 0.91; rPT = 0.69). iPT is a valid assessment of advanced laparoscopic skills for surgical trainees with higher specificity and sensitivity than rPT. As advanced minimally invasive surgery becomes more common, it is important that tasks such as iPT be included in surgical simulation curricula and training assessment.

Application of TBL and PBL in clinical teaching of laparoscopic surgery in general surgery

Objective To explore the application of team-based learning (TBL) and problem-based learning (PBL) method in clinical teaching of laparoscopic surgery in general surgery. Methods 48 students of surgery in our department were selected as the subjects to conduct the clinical teaching study. These stu-dents were divided randomly into two groups. The experimental group (24 students) adopted the method that combined TBL and PBL method, while the control group (24 students) adopted the traditional teaching method. We compared the efficacy of two groups in term of theoretical knowledge, surgical practice, com-prehensive surgical grade, and questionnaire survey. Results The score of theoretical knowledge and sur-gical practice on clipping soybean and making suturation and instrumental tie of two groups were obviously higher than that before teaching. After finishing teaching, the score of experimental group on theoretical knowledge, making suturation and instrumental tie and comprehensive surgical grade were higher than that of control group. The score of clipping soybean was similar between two groups. In addition, in term of questionnaire survey on the consciousness of independent study, the depth and width of study, and satisfac-tions to teach-ing, the TBL and PBL group had a better score than the control group. Conclusion The new teaching method which combines TBL with PBL enhances the teaching effect on theoretical knowledge and laparoscopic surgery practice. It is an effective method to train medical students. Key words: Team-based learning; Problem-based learning; Laparoscopic surgery; Teaching method

Laparoscopic and robotic skills are transferable in a simulation setting: a randomized controlled trial.

Although surgical simulation provides an effective supplement to traditional training, it is not known whether skills are transferable between minimally invasive surgical modalities. The purpose of this study was to assess the transferability of skills between minimally invasive surgical simulation platforms among simulation-naïve participants. Forty simulation-naïve medical students were enrolled in this randomized single-blinded controlled trial. Participants completed a baseline evaluation on laparoscopic (Fundamentals of Laparoscopic Surgery Program, Los Angeles, CA) and robotic (dV-Trainer, Mimic, Seattle, WA) simulation peg transfer tasks. Participants were then randomized to perform a practice session on either the robotic (N=20) or laparoscopic (N=20) simulator. Two blinded, expert minimally invasive surgeons evaluated participants before and after training using a modified previously validated subjective global rating scale. Objective measures including time to task completion and Mimic dV-Trainer motion metrics were also recorded. At baseline, there were no significant differences between the training groups as measured by objective and subjective measures for either simulation task. After training, participants randomized to the laparoscopic practice group completed the laparoscopic task faster (p<0.003) and with higher global rating scale scores (p<0.001) than the robotic group. Robotic-trained participants performed the robotic task faster (p<0.001), with improved economy of motion (p<0.001), and with higher global rating scale scores (p=0.006) than the laparoscopic group. The robotic practice group also demonstrated significantly improved performance on the laparoscopic task (p=0.02). Laparoscopic-trained participants also improved their robotic performance (p=0.02), though the robotic group had a higher percent improvement on the robotic task (p=0.037). Skills acquired through practice on either laparoscopic or robotic simulation platforms appear to be transferable between modalities. However, participants demonstrate superior skill in the modality in which they specifically train.

Investigating the Influence of Hand Dominance on Postural Sway During Traditional and Simulated Laparoscopic Surgical Skills Practice.

This study examined how hand dominance could influence postural sway during laparoscopic skills practice. Ten inexperienced medical trainees performed a peg transfer task using the Fundamentals of Laparoscopic Surgery (FLS) training box and the virtual reality (VR) trainer. Surface electromyographic recordings of upper and lower limb muscles were taken, while the postural sway was measured by a pressure mapping system. Skills performance using the non-dominant hand required more muscle effort and increased more postural sway. Compared with the FLS training box, training with VR decreased the use of muscle effort and could reduce the influence of hand dominance on the overall postural sway during laparoscopic surgical skills practice.

In Response.

Noll et al.1 remind the reader that intraperitoneal (IP) gas composition may be significantly affected by alveolar gases.2 Concerns for both combustion and embolic phenomena dictate safe laparoscopic practice. Regardless of the inspired gas mixture, the IP gases reflect those delivered from the alveoli through the blood to the peritoneum as well as the continuous replacement of the insufflation gas delivered by a pressure limit device. The ideal composition of IP gases remains to be determined. A recent Cochrane database3 could not establish the relative safety of carbon dioxide (CO2), helium, and nitrous oxide (N2O) in laparoscopic gases. Helium afforded greater hemodynamic stability in low-risk patients, and N2O appeared to confer a degree of analgesia over CO2. In this study, no mention was made of the potential for combustion, which exists most markedly for gas mixtures containing high concentrations of oxygen (O2). Although combustion is possible in the presence of bowel gases such as hydrogen and methane when N2O is present, the clinical significance of this finding is yet to be established. It is to be noted that the time to equilibrium of IP fN2O in the study by Diemunsch et al.2 in 2000 was >8 hours during ventilation with inspired fN2O = 0.66 and that fN2O at 2 hours was 0.29, suggesting that in most cases, the fN2O in peritoneal gases is insufficient to increase ignition hazards. It is the normative practice at our institution to use an inspired gas mixture of air and O2 during laparoscopic procedures, which explains why N2O was not detected in any of our samples. This is not necessarily the case in other institutions, and in many parts of the world, O2 is the only gas available, although nitrogen remains present when an extractor is used as the O2 source. In circumstances in which compressed air is not available as a component of inspired gas, using N2O as a diluent for O2 reduces, but does not eliminate, the potential for combustion, especially during electrocautery and inadvertent release of bowel gases. As noted by Noll et al.,1 in the presence of hydrogen and methane, N2O facilitates combustion.4 Both our study and those referenced by Noll et al. inform the practitioner that the mixture of gases present during laparoscopy represent a balance created by those delivered from the body and the insufflation device and reflect their physical properties, notably perfusion and blood-gas solubility characteristics. The composition of peritoneal gases is dynamic, and efforts to maintain a high level of CO2 during procedures are critical to patient safety. Both gas analysis and venting of the pneumoperitoneum5 will contribute to achieving IP gas concentrations delivered by the insufflation apparatus as intended by the practitioner. Susan P. Taylor, MD, MPH Department of Anesthesiology Children’s Hospital of Wisconsin Medical College of Wisconsin Milwaukee, Wisconsin [email protected] George M. Hoffman, MD Anesthesiology and Pediatrics Children’s Hospital of Wisconsin Medical College of Wisconsin Milwaukee, Wisconsin

PWE-417 Incentivising laparoscopic deliberate practice in core surgical training

<h3>Introduction</h3> Frequent practice using a laparoscopic simulator is known to improve subsequent live operating skills. Achieving automation of motor movements prior to live training frees the trainee’s attention for higher skills. Despite this, trainees don’t avail themselves of opportunity for practice. We incentivised frequent laparoscopic practise within two Core Surgical Training (CST) programmes. <h3>Method</h3> 27 CST’s in their first general/urology/paediatric post were given a take-home laparoscopic simulator with instrument tracking software and assigned 6 online modules. Support was provided via social media and a helpdesk. Achievement of metric targets and uploading specified data merited an eCertificate. On production of this certificate, supervisors progressed trainees from camera-holding to operating (the incentive). Trainee views of the intervention and laparoscopic practice were assessed by questionnaires. <h3>Results</h3> Metric results show improvement across all domains for those who completed 1 or more modules (presented graphically). Trainee self-rated anxiety of laparoscopic operating was reduced post-study. 94% of participants thought simulator practise was worthwhile, 76% would recommend the programme. 88% reported improved confidence and motor skills. 41% of participants completed &gt;1 modules. 19% completed all. Comments indicated reasons for this, including the need to integrate simulation into curricular structures. Metric results showed improvement in 5 domains Motion smoothness, acceleration, speed, distance between instruments,% time off screen + time to completion. <h3>Conclusion</h3> The message from this feasibility study, the first to “incentivise” laparoscopic practice, indicates that simply incentivising practice with 24/7 access to simulators and targets, doesn9t result in frequent deliberate practice by trainees, though performance improves in those who do engage. Trainee feedback provides clear indicators of what to address to maximise uptake. It would suggest that to fully engage trainees, laparoscopic practice must be fully integrated into training and progress assessed within training. <h3>Disclosure of interest</h3> L. Nicol: None Declared, R. Partridge Conflict with: Founder of E-O surgical, J. Cleland: None Declared, S. Moug: None Declared, A. Paisley: None Declared, I. Ahmed: None Declared, K. Walker: None Declared. <h3>References</h3> Nagendran M, <i>et al</i>. Laparoscopic surgical box model training for surgical trainees with no prior laparoscopic experience. Cochrane Database Syst Rev. 2014;1 Dawe SR, <i>et al</i>. A Systematic Review of Surgical Skills Transfer After Simulation-Based Training Laparoscopic Cholecystectomy and Endoscopy. Ann Surg. 2014;259(2) Zapf MA, Ujiki MB. Surgical resident evaluations of portable laparoscopic box trainers incorporated into a simulation-based minimally invasive surgery curriculum. Surg Innov. 2015;22(1):83–7

Gas Analysis Using Raman Spectroscopy Demonstrates the Presence of Intraperitoneal Air (Nitrogen and Oxygen) in a Cohort of Children Undergoing Pediatric Laparoscopic Surgery

Clinically significant gas embolism during laparoscopy is a rare but potentially catastrophic event. Case reports suggest that air, in addition to the insufflation gas, may be present. We studied the effects of equipment design and flushing techniques on the composition of gas present under experimental and routine pediatric surgical conditions. Concentrations of nitrogen (N2), oxygen (O2), and carbon dioxide (CO2) were measured by Raman spectroscopy in gas delivered to and retrieved from a mock peritoneum during simulated laparoscopy. We then analyzed the composition of insufflated and recovered gases during elective laparoscopic procedures conducted with CO2-preflushed and unflushed tubing to determine the presence of significant (10%) quantities of air. In vitro, CO2 was not detected at the distal end of insufflator tubing until after delivery of approximately 0.2 L of gas, and N2 persisted until >0.4 L was delivered, with 40% ± 8% (mean ± SD, range 33%-49%) recovered from the mock peritoneum at the termination of initial insufflation. In clinical studies, preflushing reduced the initial concentration of N2 from 78% ± 0.5% to 23% ± 15%, but >10% air was detected in all subsequent samples, regardless of insufflation technique. Laparoscopic equipment and practice routinely permit delivery of air to the insufflated cavity. Purging the equipment with CO2 reduces but does not eliminate air (N2, O2) within the peritoneal cavity during laparoscopy. Thus, when vascular injury occurs, embolized gases will contain variable quantities of N2, O2, and CO2. As the initial insufflation volume diminishes and approaches the volume of the insufflation tubing, which occurs in infants and young pediatric patients, the concentration of N2 will approximate that of room air in an unflushed system. Small insufflation volumes containing high N2 concentrations can contribute to catastrophic air emboli in neonates and small pediatric patients.

PE31: The results of 2013 survey to evaluate laparoscopic and robotic partial nephrectomy practice in the United Kingdom

PE31: The results of 2013 survey to evaluate laparoscopic and robotic partial nephrectomy practice in the United Kingdom

Impact of Advanced Laparoscopy Courses on Present Surgical Practice

The introduction of new surgical techniques has made training in laparoscopic procedures a necessity for the practicing surgeon, but acquisition of new surgical skills is a formidable task. This study was conducted to assess the impact of advanced laparoscopic workshops on caseload patterns of practicing surgeons. After we obtained institutional review board approval, a survey of practicing surgeons who participated in advanced laparoscopic courses was distributed; the results were analyzed for statistical significance. The courses were held at the University of Nebraska Medical Center between January 2002 and December 2010. Questionnaires were mailed, faxed, and e-mailed to surgeons. Of the 109 surgeons who participated in the advanced laparoscopy courses, 79 received surveys and 30 were excluded from the survey because of their affiliation with the University of Nebraska Medical Center. A total of 47 responses (59%) were received from 41 male and 6 female surgeons. The median response time from completion of the course to completion of the survey was 13.2 months (range, 6.8-19.1 months). The mean age of participating surgeons was 39.2 years (range, 29-51 years). The mean time since residency was 8.4 years (range, 0.8-21 years). Eleven surgeons had completed a minimal number of laparoscopic cases in residency (<50), 17 surgeons had completed a moderate number of laparoscopic procedures in residency (50-200), and 21 surgeons had completed a significant number of cases during residency (>200). Of the surgeons who responded, 94% were in private practice. Fifty-seven percent of the participating surgeons who responded reported a change in laparoscopic practice patterns after the courses. Of these surgeons, 24% had a limited residency laparoscopy exposure of <50 cases. Surgeons who were exposed to ≥50 laparoscopic cases during their residency showed a statistically significant increase in the number of laparoscopic procedures performed after their class compared with surgeons who did not receive ≥50 laparoscopic cases in residency (P = .03). In addition, regardless of the procedures learned in a specific class, surgeons with ≥50 laparoscopic cases in residency had a statistically significant increase in their laparoscopic colectomy and laparoscopic hernia procedure caseload (P < .01). However, there was no statistically significant difference in laparoscopic caseload between surgeons who had completed 50 to 200 laparoscopic residency cases and those who had completed greater than 200 laparoscopic residency cases (P = .31). Furthermore, the participant's age (P = .23), practice type (P = .61), and years in practice (P = .22) had no statistical significance with regard to the adoption of laparoscopic procedures after courses taken. This finding is congruent with the findings of other researchers. Future interest in advanced laparoscopy courses was noted in 70% of surgeons and was more pronounced in surgeons with ≥50 cases in residency. Advanced laparoscopic workshops provide an efficacious instrument in educating surgeons on minimally invasive surgical techniques. Participating surgeons significantly increased the number of course-specific procedures that they performed but also increased the number of other laparoscopic surgeries, suggesting that a certain proficiency in laparoscopic skills is translated to multiple surgical procedures. Laparoscopy experience of ≥50 cases during residency is a strong predictor of an increase in the number of advanced laparoscopic cases after attending courses.

Single-center Comparative Study of Laparoscopic Versus Open Colon Surgery

Kyoung Hwan Kong, M.D., Il Dong Kim, M.D., Ki Ho Kim, M.D., Jin Soo Park, M.D., Byung Sun Suh, M.D., Sang Wook Kim, M.D., Hye In Lim, M.D.. J Minim Invasive Surg 2012;15:133-7. https://doi.org/10.7602/jmis.2012.15.4.133

Current laparoscopic practice patterns among urologists in Turkey

Current laparoscopic practice patterns among urologists in Turkey

Consistently inconsistent – an audit of laparoscopic cholecystectomy consent practice

PurposeLaparoscopic cholecystectomy is one of the most commonly performed general surgical operations and is associated with several potentially serious post‐operative complications. Informed consent is vital to avoid patient misunderstanding of risk and subsequent costly litigation. Consent practice at the authors' hospital was audited with the aim of investigating the quality of consent and assessing the impact of the introduction of a detailed patient information leaflet.Design/methodology/approachIn total, the consent forms of 200 patients were examined; 100 patient consent forms were selected before and 100 after the introduction of a pre‐operative patient information leaflet, and retrospectively analysed.FindingsConsultant staff obtained only 27 per cent of consent; 64 per cent of consent was taken on the morning of surgery. The most common risks mentioned were bleeding, infection, thrombo‐embolic risks and conversion to open. Other complications were mentioned inconsistently, with only 2 per cent of patients having documented evidence of receiving the information leaflet.Originality/valueThe authors demonstrate that consent for laparoscopic cholecystectomy remains inconsistent. The introduction of an information leaflet did not improve the documentation of risk required for informed consent.

Effects of two training curricula on basic laparoscopic skills and surgical performance among veterinarians

To compare laparoscopic skills among veterinarians before and after undertaking 1 of 2 programs of simulation training. Evaluation study. 17 veterinarians at 1 institution. Basic skills were tested by use of the McGill inanimate system for training and evaluation of laparoscopic skills (MISTELS). Surgical performance was assessed through an objective structured assessment of technical skills (OSATS). Both tests were performed prior to and after a 12-session training program, consisting of MISTELS exercises (curriculum A) or a variety of exercises (curriculum B). Curriculum B led to improvement of scores obtained with both the MISTELS and the OSATS. Curriculum A did not result in higher scores obtained with the MISTELS, compared with curriculum B. Curriculum A did not lead to an improvement of scores obtained with the OSATS. Participant-perceived value of the training program was correlated positively with the improvement of scores for MISTELS suturing tasks and scores obtained with the OSATS. Time spent in clinical laparoscopic surgery and curriculum B training were both positively correlated with the post-training OSATS scores but not with post-training MISTELS scores. Conversely, simulation training time correlated with an increase in MISTELS scores but not OSATS scores. MISTELS training resulted in significant improvement of basic laparoscopic skills but not in the assessment used for surgical performance. This may have been due to the small number of study participants, the assessment tool, or the method of training. A varied curriculum may be advantageous when training veterinarians for clinical laparoscopic practice.

How to Train Surgical Residents to Perform Laparoscopic Roux‐en‐Y Gastric Bypass Safely

As a result of increasing numbers of patients with morbid obesity there is a worldwide demand for bariatric surgeons. The Roux-en-Y gastric bypass, nowadays performed mostly laparoscopically (LRYGB), has been proven to be a highly effective surgical treatment for morbid obesity. This procedure is technically demanding and requires a long learning curve. Little is known about implementing these demanding techniques in the training of the surgical resident. The aim of this study was to evaluate the safety and feasibility of the introduction of LRYGB into the training of surgical residents. All patients who underwent LRYGB between March 2006 and July 2010 were retrospectively analyzed. The procedure was performed by a surgical resident under strict supervision of a bariatric surgeon (group I) or by a bariatric surgeon (group II). The primary end point was the occurrence of complications. Secondary end points included operative time, days of hospitalization, rate of readmission, and reappearance in the emergency department (ED) within 30 days. A total of 409 patients were found eligible for inclusion in the study: 83 patients in group I and 326 in group II. There was a significant difference in operating time (129 min in group I vs. 116 min in group II; p < 0.001) and days of hospitalization. Postoperative complication rate, reappearance in the ED, and rate of readmission did not differ between the two groups. Our data suggest that under stringent supervision and with sufficient laparoscopic practice, implementation of LRYGB as part of surgical training is safe and results in only a slightly longer operating time. Complication rates, days of hospitalization, and the rates of readmission and reappearance in the ED within 30 days were similar between the both groups. These results should be interpreted by remembering that all procedures in group I were performed in a training environment so occasional intervention by a bariatric surgeon, when necessary, was inevitable.

The impact of practice environment on laparoscopic colectomy utilization following colorectal residency: a survey of the ASCRS Young Surgeons

It is often thought that practice patterns are different in private (PP) vs university hospital (UH) settings. We aimed to describe the impact of practice environment on the type of laparoscopic colectomy procedures performed by graduating colorectal surgeons. A review was carried out of prospectively gathered self-reported questionnaire data. Graduates of American Society of Colon and Rectal Surgeons' (ASCRS)-approved colorectal residencies from 2004 to 2008 underwent an on-line survey, developed by the ASCRS Young Surgeons' Committee. About 177 (52%) of 342 graduates surveyed responded. Practice setting data were available for 157 (89%) surgeons. Gender, geographical location and age were similar in both cohorts. PP surgeons utilized a laparoscopic approach more often for rectal cancer (37% vs 19%; P=0.003). There was no significant difference in the rate of laparoscopic surgery in colon cancer, diverticular disease, inflammatory bowel disease, Clostridium difficile or emergency surgery. PP surgeons operated more often with a partner (43% vs 8%) or surgical assistant (13% vs 4%; both P<0.001), while UH surgeons had a colorectal resident (10% vs 21%) or general surgery resident (15% vs 55%; both P<0.001). Impediments to performing laparoscopic surgery for PP surgeons included a perceived lack of hospital equipment (33% vs 20%) and support (29% vs 17%; both P<0.05). Perception of personal experience, access to trained assistants, financial reimbursement, length of surgery and patient availability were equivalent in both groups. While differences such as type of assistant and impediments to laparoscopic utilization exist between PP- and UH-based practices, early laparoscopic practice patterns remain similar. PP surgeons more frequently perform laparoscopic resection for rectal cancer and with hand-assistance. Despite differences, newly trained colorectal surgeons in both settings utilize and require laparoscopic skills.

Single-center Comparative Study of Laparoscopic Versus Open Colorectal Surgery

To examine the change in practice from open to laparoscopic practice in our local trust, a national training colorectal unit. Retrospective comprehensive review of clinical case notes of all colorectal resections between October 2007 and October 2009. Patients were identified through clinical coding and data were analyzed using SPSS. Comparison of 113 open versus 103 laparoscopic colorectal surgeries for various indications and short-term outcomes was made. There was an expected overall increase in the laparoscopic colorectal resections. The mean age was 73 years for open and 68 years for laparoscopic surgeries. There was no significant difference between the 2 groups with respect to age, sex, and the American Society of Anaesthesiologists. Of the 103 patients who were initially treated with laparoscopy-assisted colectomy, 12 (11.7%) were shifted to open procedures. Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group, as reflected by a shorter hospital stay (median, 8 vs. 13 d). The overall complication rate was significantly less in the laparoscopy-assisted colectomy group than in the open-colectomy group (33% vs. 46%, P=0.05). Our local hospital practices support the many benefits of laparoscopic colorectal surgery. Substantial improvements in rates of hospital stay and wound infection were noted, hence shifting our practice safely in a district general hospital.

Upper tract urologic LaparoEndoscopic Single-Site surgery.

LaparoEndoscopic Single-Site (LESS) surgery has been developed as an extension of conventional laparoscopy to provide a minimally invasive option with fewer incisions, minimizing scars and potentially improving postoperative convalescence. These techniques have been adopted in the practice of urologic surgery, and largely employed to date for upper tract surgery by urologists in specialized centers with advanced laparoscopic practices. Herein, we review the current experience with upper tract urologic LESS surgery.

Animal model for training in laparoscopic pyeloplasty

ObjectiveWith the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. Laparoscopic pyeloplasty has been one of the most developed techniques. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described. MethodsEight procedures of laparoscopic pyeloplasty were performed using the animal model (Gallus gallus) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as p<0.05. ResultsThe laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14min to a minimum of 6min, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65min to a minimum of 43min, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen. ConclusionsThe animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture.

Modelo animal de entrenamiento en pieloplastia laparoscópica

Objective With the coming of the laparoscopy, multiple surgical techniques have been developed that have revolutionized the urological practice. The laparoscopic pyeloplasty has been one of the techniques most developed. However, there are very few training models that permit the surgeon to decrease the learning curve. An animal model of training for the laparoscopic pyeloplasty technique is described. Methods Eight procedures of laparoscopic pyeloplasty were performed using the animal model (Gallus gallus) in the laparoscopic practice laboratory of the Urology Service of the University Hospital of Caracas. The preparation times of the model and the operation times of each surgeon were compared. The statistical analysis was made calculating the mean operation time, standard deviation, frequencies and percentages. A significant value was considered as p < 0.05. Results The laparoscopic pyeloplasty procedure was performed successfully in all of the cases by two surgeons. The preparation time ranged from a maximum of 14 minutes to a minimum of 6 minutes, this being the same for both surgeons in the fourth case. The operation time ranged from a maximum of 65 minutes to a minimum of 43 minutes, observing significant differences when comparing the times individually for each surgeon. Only one case had filtration when comparing the patency of the specimen. Conclusions The animal model of training of laparoscopic pyeloplasty that is described is economical, reproducible, of easy availability and it makes it possible to develop laparoscopic surgical skills and competency necessary for reconstructive surgery and techniques that warrant intracorporeal suture.

S141 CURRENT LAPAROSCOPIC PRACTICE PATTERNS AMONG UROLOGISTS IN TURKEY

Objective: Laparoscopic surgery has become increasingly popular in urology over the last decade. This survey was performed to evaluate the current practice patterns in laparoscopy among urologists in Turkey. Material and methods: A detailed questionnaire about urologic laparoscopic practice patterns was distributed to 1242 urologists who were working in Turkey. The questions pertained to age, practice demographics, and the amount and variety of laparoscopy performed. Results: Nearly half of the respondents (48.3%) already performed laparoscopy. Of the urologists in academic settings, including university hospitals and education and research hospitals, 69.6% and 59.4% performed laparoscopy, respectively. In state hospitals, the percentage of those who performed laparoscopy was lower (26.9%). The most important reasons mentioned for performing laparoscopy were shorter hospital stay, patient requests and greater flexibility of possible surgical techniques. The main laparoscopic procedures performed were nephrectomy (benign indication), 91%; renal cyst decortications, 90%; nephrectomy (malign indication), 65%; laparoscopic stone surgery, 47% and pyeloplasty, 38%. A large percentage (77.2%) of respondents intended to attend continuing education and to perform laparoscopy in the future. Conclusions: Our results show that laparoscopic practice steadily increases in frequency and that urologists are willing to substitute open surgery for laparoscopic surgery. The performance of laparoscopic surgery has become a goal for most urologists in Turkey to achieve in the near future.