title: Surgical performance during laparoscopic radical nephrectomy is improved with training in a porcine model.
abstract: OBJECTIVE
  Becoming proficient in laparoscopic surgery is dependent on the acquisition of specialized skills that can only be obtained from specific training. This training could be achieved in various ways using inanimate models, animal models, or live patient surgery--each with its own pros and cons. Currently, there are substantial data that support the benefits of animal model training in the initial learning of laparoscopy. Nevertheless, whether these benefits extent themselves to moderately experienced surgeons is uncertain. The purpose of this study was to determine if training using a porcine model results in a quantifiable gain in laparoscopic skills for moderately experienced laparoscopic surgeons.
  
  
  METHODS
  Six urologists with some laparoscopic experience were asked to perform a radical nephrectomy weekly for 10 weeks in a porcine model. The procedures were recorded, and surgical performance was assessed by two experienced laparoscopic surgeons using a previously published surgical performance assessment tool. The obtained data were then submitted to statistical analysis.
  
  
  RESULTS
  With training, blood loss was reduced approximately 45% when comparing the averages of the first and last surgical procedures (P=0.006). Depth perception showed an improvement close to 35% (P=0.041), and dexterity showed an improvement close to 25% (P=0.011). Total operative time showed trends of improvement, although it was not significant (P=0.158). Autonomy, efficiency, and tissue handling were the only aspects that did not show any noteworthy change (P=0.202, P=0.677, and P=0.456, respectively).
  
  
  CONCLUSIONS
  These findings suggest that there are quantifiable gains in laparoscopic skills obtained from training in an animal model. Our results suggest that these benefits also extend to more advanced stages of the learning curve, but it is unclear how far along the learning curve training with animal models provides a clear benefit for the performance of laparoscopic procedures. Future studies are necessary to confirm these findings and better understand the impact of this learning tool on surgical practice.
authors.affiliation: Department of Urology, College of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil.
authors.forename: José Arnaldo Shiomi da
authors.initials: JA
authors.lastname: Cruz
authors.forename: Carlo Camargo
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Rodrigo Marcus Cunha
authors.initials: RM
authors.lastname: Frati
authors.forename: Sabrina Thalita Dos
authors.initials: ST
authors.lastname: Reis
authors.forename: Marcelo Takeo Rufato
authors.initials: MT
authors.lastname: Okano
authors.forename: Eder Maxwell
authors.initials: EM
authors.lastname: Gouveia
authors.forename: Karlo Dornelles
authors.initials: KD
authors.lastname: Biolo
authors.forename: Ricardo Jordão
authors.initials: RJ
authors.lastname: Duarte
authors.forename: Hiep
authors.initials: H
authors.lastname: Nguyen
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D003867:Depth Perception; D010535:Laparoscopy / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D023421:Models, Animal; D009392:Nephrectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D011361:Professional Competence; D034421:Sus scrofa / Q000601:surgery*; D013997:Time Factors