Training In Laparoscopic Surgery Research Articles

619 Training the Trainees in Robotic Surgery – a UK Pilot Scheme

Abstract Aim Training the trainees in robotic surgery is a specialised and crucial process, given the precision and complexity involved in performing operations using robotic systems. Robotic training for trainees is challenging due to limited access to robotic systems and the lack of training opportunities. We describe how we implemented a training programme for trainees at West Hertfordshire Teaching Hospitals (WHTH) NHS Trust within a year of the consultants starting their robotics programme. Method Specialist trainees at WHTH who would have been offered training in laparoscopic surgery in colorectal, upper gastrointestinal and general surgery were selected to train as console surgeons on the CMR Surgical Versius system. All trainees had been on a first assist course and had experience in assisting in robotic surgery. Training included online modules, metrics-based virtual training, and technical skills assessment. Live operating was supervised by consultant trainers who sat beside the trainee. Results Six trainees ranging from ST4 to ST8 level were selected to partake in the training programme over a period of six months. Operations were broken down into modular parts and included segmental colectomies, anterior resections, cholecystectomy, and inguinal hernia repair. The trainees have participated in over thirty operations. Feedback from consultant trainers was given verbally and through work-based assessments. No adverse events were reported in training cases. Conclusions Robotic surgical training for specialist trainees can be implemented safely and in a timely manner. Objective metrics such as docking time, console time and volumetric hand motion may help with trainee assessment in the future.

Enhancing clinical proficiency through laparoscopic training using Japanese origami

ObjectiveThis study aimed to investigate the clinical efficacy of laparoscopic training using origami, a traditional Japanese papercraft, using laparoscopic forceps to create origami cranes. MethodsIn this retrospective study, 4 surgeons were randomly divided into 2 groups: The training group, consisting of surgeons 1 and 2, and the non-training group, consisting of surgeons 3 and 4. Over the course during a one-year study period, the training group regularly underwent laparoscopic surgery training with a dry box wherein they folded a total of 1000 origami cranes using laparoscopic instruments. The non-training group periodically underwent common laparoscopic surgery training of techniques such as suturing and ligation. Each surgeon regularly performed the transabdominal preperitoneal approach for inguinal hernias. Each training was conducted concurrently with the surgeries. The procedure time (peritoneum detachment, mesh placement, and closure of the peritoneum), total operation time (time from peritoneum detachment to closure of the peritoneum), and surgical outcomes were examined. ResultsThe training group showed greater improvement in the total operation time and more stable performance than the non-training group. Additionally, the time taken for peritoneum detachment was significantly shorter in the training group. ConclusionLaparoscopic training using origami has the potential to enhance laparoscopic surgical skills and improve surgical outcomes.

Original Training for Laparoscopic Surgery by Making an Origami Paper Crane.

The training box is an effective tool used by surgical trainees. Suturing training is the common method of practicing laparoscopic surgery; however, the cost of needles and threads for long-term practice remains a problem. In this study, we incorporated the original Japanese training for laparoscopic surgery by making an origami paper crane (laparoscopic origami training (LOT)) and evaluated its effect on the clinical results as a long-term practice. LOT was performed using a single 7.5 × 7.5 cm origami paper in the training box of laparoscopic surgery. In the bench-top study, the total time required to make one paper crane was measured and evaluated, and a self-efficacy questionnaire was designed to analyze the efficacy of LOT. In clinical practice, we retrospectively compared two resident groups, one that had previously trained on LOT (trained group) and the other that did not (less-trained group), by analyzing the pneumoperitoneum time (PT) for 10 cases. After making paper cranes in approximately 100 cases, the making time was reduced to approximately 10 min. Long-term results analyzing up to 1500 cases revealed that in addition to shortening the time required to make a paper crane, the shape of the crane also improved. Consequently, the median PT was significantly shorter in the trained group than in the less-trained group (129.0 (62-287) versus 208.5 (127-343) min; p<0.001). LOT contributed to introducing safe laparoscopic surgery to residents and improved their laparoscopic outcomes. We believe that this is a useful practice methodology that can be recommended to general physicians who wish to practice laparoscopic surgeries.

Virtual reality simulation training in laparoscopic surgery – does it really matter, what simulator to use? Results of a cross-sectional study

BackgroundVirtual reality simulation training plays a crucial role in modern surgical training, as it facilitates trainees to carry out surgical procedures or parts of it without the need for training “on the patient”. However, there are no data comparing different commercially available high-end virtual reality simulators.MethodsTrainees of an international gastrointestinal surgery workshop practiced in different sequences on LaparoS® (VirtaMed), LapSim® (Surgical Science) and LapMentor III® (Simbionix) eight comparable exercises, training the same basic laparoscopic skills. Simulator based metrics were compared between an entrance and exit examination.ResultsAll trainees significantly improved their basic laparoscopic skills performance, regardless of the sequence in which they used the three simulators. Median path length was initially 830 cm and 463 cm on the exit examination (p < 0.001), median time taken improved from 305 to 167 s (p < 0.001).ConclusionsAll Simulators trained efficiently the same basic surgery skills, regardless of the sequence or simulator used. Virtual reality simulation training, regardless of the simulator used, should be incorporated in all surgical training programs. To enhance comparability across different types of simulators, standardized outcome metrics should be implemented.

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization

PurposeBeside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices.Methods48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks “PEG Transfer”, “Pattern Cut” and “Intracorporeal Suture” and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance.ResultsIn 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group.ConclusionWe could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

Towards engineering a portable platform for laparoscopic pre-training in virtual reality with haptic feedback

BackgroundLaparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body. For some time, efforts have been made to improve surgical pretraining through practical exercises on abstracted and reduced models. MethodsThe authors strive for a portable, easy to use and cost-effective Virtual Reality-based (VR) laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens. Current VR controllers are limited regarding haptic feedback. Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training, the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback, a commercially available head-mounted display, a VR environment for simulating a laparoscopic surgery, and a training concept. ResultsTo take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training, the system shall not require a tissue sample for haptic feedback. It is currently calculated and visually displayed to the user in the VR environment. On the prototype controller, a first axis was provided with perceptible feedback for test purposes. Two of the prototype VR controllers can be combined to simulate a typical both-handed use case, e.g., laparoscopic suturing. A Unitybased VR prototype allows the execution of simple standard pre-trainings. ConclusionsThe first prototype enables full operation of a virtual laparoscopic instrument in VR. In addition, the simulation can compute simple interaction forces. Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback. Mechanical weaknesses were identified in the first hardware prototype, which will be improved in subsequent versions. All degrees of freedom of the controller are to be provided with haptic feedback. To make forces tangible in the simulation, characteristic values need to be determined using real tissue samples. The system has yet to be validated by cross-comparing real and VR haptics with surgeons.

AB004. Education for all: enhancing high-quality laparoscopic surgery training for surgeons in remote communities of Ecuador

AB004. Education for all: enhancing high-quality laparoscopic surgery training for surgeons in remote communities of Ecuador

11. UPDATED VALIDATION OF 3D PRINTING-BASED TRAINING TOOLS FOR TRANSANAL SURGERY

Abstract Introduction Due to the complexity of colorectal surgery, the development of specialised training tools is necessary to improve the technical skills of surgeons in a controlled environment. In the framework of the MIREIA Project, this study proposes an updated design of a toolkit to provide a safe and effective environment for colorectal surgery training. Methods Work was carried out on the design of a silicone colon model using injection moulds, consisting of two components (the colon model and its wrap), using the fused deposition 3D printing technique. Two layers of silicone were added to simulate the mucosal and muscular layers. A group of surgeons evaluated the formative utility of the model in transanal surgery, performing resection and suturing of polyps inside the model. Results According to the results of the validation study, the silicone colon model showed adequate behaviour during insufflation and a positive haptic response to contact with laparoscopic forceps. This model accurately reproduces the layers of the colon and allows customisation for each patient. In addition, polyp removal is realistic and the elastic layers support stitches, providing greater realism during surgery. Conclusion A realistic simulator has been developed for training in transanal laparoscopic surgery, but improvements in the final design are needed for widespread implementation. The application of an aqueous gel on the mucosal layer is proposed to improve the realism of the training.

Modeling of Learning Processes Using Continuous-Time Markov Chain for Virtual-Reality-Based Surgical Training in Laparoscopic Surgery.

Recent usage of Virtual Reality (VR) technology in surgical training has emerged because of its cost-effectiveness, time savings, and cognition-based feedback generation. However, the quantitative evaluation of its effectiveness in training is still not studied thoroughly. This paper demonstrates the effectiveness of a VR-based surgical training simulator in laparoscopic surgery and investigates how stochastic modeling represented as Continuous-time Markov-chain (CTMC) can be used to explicit the training status of the surgeon. By comparing the training in real environments and in VR-based training simulators, the authors also explore the validity of the VR simulator in laparoscopic surgery. The study further aids in establishing learning models of surgeons, supporting continuous evaluation of training processes for the derivation of real-time feedback by CTMC-based modeling.

Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

Symptom Duration and Surgeon Volume: Impact on Early Laparoscopic Cholecystectomy for Acute Cholecystitis.

The 'golden 72 hours' rule from the onset of symptoms still applies in laparoscopic cholecystectomy for acute cholecystitis. This rule has been discussed with increasing experience in laparoscopic surgery in recent years. This study aims to determine the optimal symptom duration based on the surgeon's volume when deciding on early laparoscopic cholecystectomy for acute cholecystitis. The patients were categorized into two groups: Group 1 (≤3 days) and Group 2 (>3 days) based on the symptom duration, andhigh-volume surgeons (performing >100 laparoscopic cholecystectomies in a year) and low-volume surgeons (performing <100 laparoscopic cholecystectomies in a year) based on the surgeon volume. All surgeons had received advanced training in laparoscopic surgery. There was no statisticaldifference in postoperative outcomes between groups, except for a few data (p>0.05). The operative time was longer in Group 2, the postoperative hospital stay was longer for low-volume surgeons than for high-volume surgeons after three days, and operative time was longer after three days than the first three days in low-volume surgeons (p<0.05). Early laparoscopic cholecystectomy may be recommended for acute cholecystitis with symptom duration of more than three days, regardless of the surgeon volume, as long as they are competent in laparoscopic surgeries.

Exploring Laparoscopic Surgery Training Opportunities in the College of Surgeons of East, Central, and Southern Africa region

The resource-limited environment in Sub-Saharan countries, with a lack of expert trainers, impedes the progress of laparoscopic training. This study aimed to identify the opportunities and limitations of laparoscopic surgery training in the College of Surgeons of East, Central, and Southern Africa (COSECSA) countries. A multicountry online survey was conducted from January 2021 to October 2021 in COSECSA-accredited training hospitals within 16 countries. Available resources and challenges faced in order to set up well-structured laparoscopic training programs were explored. Ninety-four surgeons answered the questionnaire. The average resources reported per hospital were 3 trained laparoscopic surgeons, 2 laparoscopic towers, and 2 sets of laparoscopic instruments. The training of the majority of these surgeons has been in local institutions (53%), a further 37% within African countries and only 10% outside Africa. Approximately 45% of them declared that laparoscopic modules were planned within the University Curricula, while only 18% of surgeons recognized that laparoscopic modules are only planned within the COSECSA program. About 57% of participants reported that at the end of residency training, graduating surgeons were not able to perform basic laparoscopic procedures. The quoted barriers included: limited laparoscopic equipment, absence of simulation lab, lack of qualified trainers, lack of training programs and time for teaching by skilled doctors, and lack of institutional support. The well-structured set up of laparoscopic training programs in the COSECSA region is hindered due to the lack of qualified personnel and insufficient resources for the acquisition of equipment and simulation laboratories. Ongoing efforts to set up laparoscopic programs through the development of adaptive curricula, innovative strategies for reduction of equipment cost and adequate training of surgeons are crucial for patient safety and the development of laparoscopy.

Laparoscopic training on virtual-reality simulators or live pigs-a randomized controlled trial.

Thirty-six novice surgical residents without independent laparoscopic experience were randomly paired with a peer and randomized into three groups: VR simulator group (dyad training on LapSim VR simulators), pig surgery group (training on live, anesthetized pigs) and control group (training by a lecture on laparoscopic surgery, surgical videos and textbooks). After 6h of training, all participants performed a simulated cholecystectomy procedure using a pig liver with adherent gallbladder working in pairs. All procedures were video-recorded and the recordings were saved on USB-sticks in a blinded fashion identifiable only by the unique participant number. All video-recordings were scored blindly and independently by two expert raters using the Global Operative Assessment of Laparoscopic Skills (GOALS) assessment instrument. The performances in the three groups were significantly different, P less than 0.001. Both the VR simulation training group and the live pigs training group performed significantly better than the control group, both P values less than 0.001. However, there was no significant difference in the performance of the two simulation-based training groups, P=0.66. Novice surgical trainees can benefit from both VR simulator training and pig surgery simulation compared with traditional studying and there was no significant difference between the two modalities. The authors recommend that VR simulators should be used for basic training of laparoscopic skills and surgery on live animals should be reserved for higher-level surgical training.

Laparoscopy in Low- and Middle-Income Countries: A Survey Study.

An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs) has impelled the need for implementing laparoscopic surgery, a safe and cost-effective surgical service. However, despite countless benefits, laparoscopic surgery programs remain limited throughout LMICs, and limited understanding is known of healthcare professionals' views regarding the implementation of laparoscopic surgery in their local healthcare environments. Therefore, the purpose of this study is to better understand the perceived challenges and barriers to implementing long-term laparoscopic surgery programs from the perspective of healthcare professionals. Upon receiving ethical approval from the McGill University Health Center (MUHC), a nine-question survey (concerning attributes required to establish a successful laparoscopic program in LMICs and to gain insight into what surgeons from LMICs believed were the necessary next steps) was pilot tested amongst faculty members, and subsequently disseminated to healthcare professionals practicing in LMICs. Explicit consent was obtained from the participants before answering the survey. Results: Thirty-four participants representing a total of 35 countries participated in the survey with the majority having received laparoscopic surgery training. Overall, participant responses were characterized by two major themes. Highlighted in the first theme, Laparoscopic Experience and Training Curriculum, were responses concerning current laparoscopic training and education, improved career opportunities provided by laparoscopic training, and a particular existing potential to incorporate laparoscopic surgery into the current surgical curriculum at various levels of training. Emphasized in the second theme, Challenges and Next Steps, were responses concerning barriers to the implementation of laparoscopic surgery, current institutional capabilities, and the need for improving mentorship through existing surgical societies such as the College of Surgeons of East, Central, and Southern Africa (COSECSA), West African College of Surgeons (WACS), and The Pan-African Academy of Christian Surgeons (PAACS). A buy-in from the government, hospitals, staff, and industry is crucial for the long-term implementation of laparoscopic surgery in LMICs, which can only be accomplished through increased advocacy and the dissemination of the benefits of minimally invasive surgery both economically and socially.

Is Laparoscopic Oncological Surgery After an Open Surgery Possible?

This paper presents a case of a 55-year-old male patient with pain in the right lumbar region and hematuria. An abdominopelvic computed tomography was performed, and a tumor was discovered in the right renal pelvis. An open right radical nephrectomy was performed. She returned again with hematuria, thus cystoscopy, ureteroscopy, and selective cytology were performed, and local recurrence in the right ureter was documented. A radical right radical ureterectomy with laparoscopic bladder encirclement and extended lymphadenectomy was performed, with a histopathological report of right ureter with low-grade urothelial carcinoma. The patient showed satisfactory progress and was monitored. With this article, we stress that with adequate training, experience, and practice in laparoscopic surgery, excellent oncological and aesthetic results can be obtained, which is comparable to open surgery, but with the benefit of rapid recovery and less pain and bleeding. Therefore, we believe that with practice, laparoscopic oncological surgery after an open surgery is perfectly feasible.

Video game experience affects performance, cognitive load, and brain activity in laparoscopic surgery training.

Video games can be a valuable tool for surgery training. Individuals who interact or play video games tend to have a better visuospatial ability when compared to non-gamers. Numerous studies suggest that video game experience is associated with faster acquisition, greater sharpening, and longer retention of laparoscopic skills. Given the neurocognitive complexity of surgery skill, multimodal approaches are required to understand how video game playing enhances laparoscopy skill. Twenty-seven students with no laparoscopy experience and varying levels of video game experience performed standard laparoscopic training tasks. Their performance, subjective cognitive loading, and prefrontal cortical activity were recorded and analyzed. As a reference point to use in comparing the two novice groups, we also included data from 13 surgeons with varying levels of laparoscopy experience and no video game experience. Results indicated that video game experience was correlated with higher performance (R2 = 0.22, p <0.01) and lower cognitive load (R2 = 0.21, p <0.001), and the prefrontal cortical activation of students with gaming experience was relatively lower than those without gaming experience. In terms of these variables, gaming experience in novices tended to produce effects similar to those of laparoscopy experience in surgeons. Our results suggest that along the dimensions of performance, cognitive load, and brain activity, the effects of video gaming experience on novice laparoscopy trainees are similar to those of real-world laparoscopy experience on surgeons. We believe that the neural underpinnings of surgery skill and its links with gaming experience need to be investigated further using wearable functional brain imaging.

Impact of Resident Post-Graduate Year on Laparoscopic Cholecystectomy Outcomes.

Introduction Laparoscopic cholecystectomy is a minimal access procedure in which the gallbladder is removed by laparoscopic techniques. Effective training for laparoscopic surgery should focus on not only understanding the anatomy and procedural steps but also acquiring the specific gestures and techniques of this type of surgery that may differ from those used in traditional open surgery. The aim of our study was to analyze whether the laparoscopic cholecystectomy performed by surgeons in training is a safe procedure. Material and methods This is a retrospective review of 433 patients who were divided into two groups: laparoscopic cholecystectomies performed by trainees and those performed by senior surgeons. Results Around 66% of surgeries were performed by resident surgeons. There was no demographic difference between residents and senior surgeons. Operative time was significantly longer in the residents' group compared to senior surgeons' group (96 minutes vs 61 minutes; p<0.001). The overall intra- and post-operative complication rates were 3.1% and 2.5%, respectively, with no significant difference between the two groups (p=0.368 and p=0.223). Conversion to open laparotomy was required in 8% of cases in each group (p=0.538). The mean length of hospital stay after surgery was significantly longer in patients operated by residents (p<0.001). We did not notice any case of mortality in both groups.

3D Autonomous Surgeon’s Hand Movement Assessment Using a Cascaded Fuzzy Supervisor in Multi-Thread Video Processing

The purpose of the Fundamentals of Laparoscopic Surgery (FLS) training is to develop laparoscopic surgery skills by using simulation experiences. Several advanced training methods based on simulation have been created to enable training in a non-patient environment. Laparoscopic box trainers-cheap, portable devices-have been deployed for a while to offer training opportunities, competence evaluations, and performance reviews. However, the trainees must be under the supervision of medical experts who can evaluate their abilities, which is an expensive and time-consuming operation. Thus, a high level of surgical skill, determined by assessment, is necessary to prevent any intraoperative issues and malfunctions during a real laparoscopic procedure and during human intervention. To guarantee that the use of laparoscopic surgical training methods results in surgical skill improvement, it is necessary to measure and assess surgeons' skills during tests. We used our intelligent box-trainer system (IBTS) as a platform for skill training. The main aim of this study was to monitor the surgeon's hands' movement within a predefined field of interest. To evaluate the surgeons' hands' movement in 3D space, an autonomous evaluation system using two cameras and multi-thread video processing is proposed. This method works by detecting laparoscopic instruments and using a cascaded fuzzy logic assessment system. It is composed of two fuzzy logic systems executing in parallel. The first level assesses the left and right-hand movements simultaneously. Its outputs are cascaded by the final fuzzy logic assessment at the second level. This algorithm is completely autonomous and removes the need for any human monitoring or intervention. The experimental work included nine physicians (surgeons and residents) from the surgery and obstetrics/gynecology (OB/GYN) residency programs at WMU Homer Stryker MD School of Medicine (WMed) with different levels of laparoscopic skills and experience. They were recruited to participate in the peg-transfer task. The participants' performances were assessed, and the videos were recorded throughout the exercises. The results were delivered autonomously about 10 s after the experiments were concluded. In the future, we plan to increase the computing power of the IBTS to achieve real-time performance assessment.

MANAGEMENT OF BILE DUCT INJURY IN A REFERRAL CENTER, 10 YEARS OF EXPERIENCE

Abstract Introduction Bile duct injury represents major morbidity and mortality, and in the last two decades in which laparoscopy cholecystectomy has been universally available several factors associated with bile duct injury have been described: one of them being the surgeon's training and experience in laparoscopic cholecystectomy. Some authors have reported that the training curve stabilizes the risk of bile duct injury from 1.7 to 0.17% by procedure number 50. Given that most surgical residency programs don't have enough experience in laparoscopy, this likely contributes to the development of bile duct injury. Therefore, it is important to elucidate the risk factors for bile duct injury in our country. Methods In a referral center we collected the data from 10 years of experience in bile duct repair for bile duct injury. The clinical records for 83 patients were obtained and analyzed. Results High-quality hepaticojejunostomy was performed in all 117 cases, 89.8% open, 8.5% laparoscopic and 1.7% was converted from laparoscopic to open. In 41% of patients, partial resection of the IV segment was necessary. the main post-operatory complication was surgical site infection in 19.6%, overall mortality was 3.4%. according to McDonald Classification for Group A 56.4%, Group B 28.2%, Group C 10.2%, Group D 5.2%, in long-term follow-up. Conclusions Surprisingly, the open cholecystectomy was the most common procedure associated with bile duct injury in our population. Postoperative injury detection was the most frequent, and the most common injury location was near the confluence. We obtained good long-term results even the type of injuries. The disproportion between training centers and hospitals all around the country may impact these results due to the lack of experience of the young surgeons that have only had training in laparoscopic surgery and the lack of universal laparoscopic availability for emergencies. The patients that suffer from this complication are of middle age, and there is a significant disproportion between males and females, with females being the most affected group. It has an impact on their quality of life. High-quality hepaticojejunostomy with Hepp-couinaud technique provides good long-term results, with no difference between the 1–5 year and the 6–10 year groups. The segment IV hepatectomy represents a good option to access the hilar plate. It is important to continue to expose surgeons during their residencies to open cholecystectomy. Prevention is the cheapest and safest way to decrease the incidence of bile duct injury. The implementation of high-volume centers such as ours is important to bring early and high-quality solutions to problems like these.

The impact of laparoscopic gynecological surgery training on the technicity index of a developing country center.

To compare laparoscopic gynecological surgery training between a developed country's reference center (host center) and a public reference service in a developing country (home center), and use the technicity index (TI) to compare outcomes and to determine the impact of laparoscopic gynecological surgery fellowship training on the home center's TI. The impact of training on the home center was assessed by comparing surgical performance before and after training. TI was assessed in 2017 in the host center, and before and after training in the home center. Epidemiological and clinical data, and information on reason for surgery, preoperative images, estimated intraoperative bleeding, operative time, surgical specimen weight, hospital stay length, complication and reintervention rates were collected from both institutions. Home center pre-training data were retrospectively collected between 2010 and 2013, while post-training data were prospectively collected between 2015 and 2017. A two-tail Z-score was used for TI comparison. The analysis included 366 hysterectomies performed at the host center in 2017, and 663 hysterectomies performed at the home center between 2015 and 2017. TI in the host center was 82.5%, while in the home center it was 6% before training and 22% after training. There were no statistical differences in length of hospital stay, preoperative uterine volume, surgical specimen weight and complication rate between centers. However, significantly shorter mean operative time and lower blood loss during surgery were observed in the host center. High-quality laparoscopic training in a world-renowned specialized center allowed standardizing laparoscopic hysterectomy procedures and helped to significantly improve TI in the recipient's center with comparable surgical outcomes.