Training in laparoscopic urology.
OBJECTIVE
Training in laparoscopy has become an important issue in the current surgical scenario. In this overview we aim to update the current knowledge in the field of laparoscopic urological training and to highlight the potential dangers of using simulation for accreditation and selection purposes at this stage.


RESULTS
Physical simulators are widely available and seem to be equally efficient as virtual reality simulators. Transfer of training has been proven to be beneficial in randomized controlled trials for virtual reality and cholecystectomy. A model for the vesico-urethral suture has been described and integrated in a skills laboratory program. The program has construct validity and can discriminate at least between beginners and advanced laparoscopists. Efforts have still to be made in defining appropriate tools to assess competence and evidence for reliability, and validity must be obtained before including simulators in accreditation programs.


CONCLUSIONS
In spite of the abundant literature there is still little evidence about the learning mechanism involved in acquiring laparoscopic skills. Physical and virtual reality simulators have been proven to be efficient in improving dexterity and some evidence exists of a positive transfer from virtual reality to the operating room in cholecystectomy. Very few models, however, have been described for reconstructive urology, and effective transfer to the operating room has not yet been proven, although validation work is in progress in the field of urology.
Department of Urology, Academic Medical Center, Amsterdam, The Netherlands. m.p.lagunapes@amc.uva.nl
Ma Pilar
MP
Laguna
Theodorus M
TM
de Reijke
Hessel
H
Wijkstra
Jean
J
de la Rosette
D002983:Clinical Competence; D003194:Computer-Assisted Instruction; D004501:Education, Medical; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D012371:Robotics; D014572:Urology / Q000193:education*; D014584:User-Computer Interface