title: The anterior abdominal wall in laparoscopic procedures and limitations of laparoscopic simulators.
abstract: BACKGROUND
  Maneuvers involving two-handed techniques such as intracorporeal suturing and knot-tying during laparoscopy are intrinsically more difficult than ones performed during open surgery.
  
  
  METHODS
  The use of simulators to practice and teach specialized techniques is established. However, simulators vary greatly, and few, as yet, represent the abdominal wall well.
  
  
  RESULTS
  This study has shown that the working angle between instruments during laparoscopic cholecystectomy is 78 degrees, and this can be increased to 117 degrees by moving the instruments laterally. In contrast, the working angle in four trainers assessed was never greater than 77 degrees.
  
  
  CONCLUSIONS
  This suggests that some maneuvers may be more difficult in trainers than at surgery. This has implications for training and the further development of more realistic simulators.
authors.affiliation: Aberdeen Royal Infirmary, Scotland, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: McIntyre
authors.forename: C P
authors.initials: CP
authors.lastname: Driver
authors.forename: S S
authors.initials: SS
authors.lastname: Miller
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D008953:Models, Anatomic