The rabbit nephrectomy model for training in laparoscopic surgery.
BACKGROUND
Laparoscopic surgical training is generally done with the teacher-student model using complex exercises. This study was performed to evaluate a new training model that emphasizes the repetition of simple procedures.


METHODS
Laparoscopic surgery was performed in rabbits (n=200) using conventional instruments. Gynaecologists (n=10) and medical students (n=10) performed a series of exercises during 20 full days training. Nephrectomy was chosen to evaluate and score laparoscopic skills, i.e. duration of surgery and complication rate, since it mimics the surgical challenge and involves dissection of major vessels. Each surgeon performed 20 nephrectomies, alternating left and right sides.


RESULTS
Duration of surgery and complications decreased with training. For duration of surgery, a two-phase exponential decay learning curve, with different decays for gynaecologists and students, was observed. Gynaecologists achieved shorter operating times than students for real and calculated times in the first procedure (P<0.0001 and P<0.0001) and for calculated time in the last procedure (P=0.001). Severe complications were more frequent in students than in gynaecologists (P=0.0003).


CONCLUSIONS
The rabbit nephrectomy model is suitable for training in laparoscopic surgery. Since it implies the repetition of short and well-defined exercises, progression is easier to monitor and the necessity for continuous supervision is less, making training less expensive.
Molinas
Carlos Roger
CR
Centre for Surgical Technologies, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. Roger.Molinas@uz.kuleuven.ac.be
Binda
Maria Mercedes
MM
Mailova
Karina
K
Koninckx
Philippe Robert
PR
D000818:Animals; D004496:Education, Continuing; D004501:Education, Medical; D006176:Gynecology / Q000193:education; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D023421:Models, Animal; D009392:Nephrectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D011817:Rabbits; D013337:Students, Medical; D013997:Time Factors