title: Single-incision laparoscopy: training, techniques, and safe introduction to clinical practice.
abstract: BACKGROUND
  Single-incision laparoscopy is an emerging technique that brings new challenges to laparoscopy and introduces new skills that a surgeon must learn. The learning needs for single-incision skills acquisition are unknown and no current guidelines exist for training or for its safe adoption.
  
  
  METHODS
  We developed an approach to adoption of new surgical techniques and applied it to single-incision laparoscopy. It is based on the following principles: a defined training algorithm, dry and wet-laboratory practice, a graded clinical introduction, and careful review of early outcomes. We analyzed its impact in our initial 40 patients.
  
  
  RESULTS
  Our training paradigm consisted of the following: attending a formal course, developing a simulation model, and animal laboratory training, followed by graduated clinical adoption. A 20% conversion rate to standard laparoscopy or open surgery occurred.
  
  
  CONCLUSIONS
  Introducing a new surgical technique may not only offer potential advantages but also present significant risks. We developed a thoughtful approach to adoption that includes simulation-based training, progressive clinical adoption, and early review of outcomes. This approach may be applied to various new clinical applications.
authors: Department of Surgery, The Center for Videoendoscopic Surgery, The Institute for Simulation and Interprofessional Studies, University of Washington, Seattle, Washington, USA. skhandel@u.washington.edu
authors: Saurabh
authors: S
authors: Khandelwal
authors: Andrew S
authors: AS
authors: Wright
authors: Edgar
authors: E
authors: Figueredo
authors: Carlos A
authors: CA
authors: Pellegrini
authors: Brant K
authors: BK
authors: Oelschlager
mesh_terms: D000818:Animals; D001062:Appendectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education / Q000379:methods; D004502:Education, Medical, Continuing; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education / Q000379:methods*; D023421:Models, Animal