title: Advanced training in laparoscopic abdominal surgery: a systematic review.
abstract: BACKGROUND
  Simulation has spread widely this last decade, especially in laparoscopic surgery, and training out of the operating room has proven its positive impact on basic skills during real laparoscopic procedures. Few articles dealing with advanced training in laparoscopic abdominal surgery, however, have been published. Such training may decrease learning curves in the operating room for junior surgeons with limited access to complex laparoscopic procedures as a primary operator.
  
  
  METHODS
  Two reviewers, using MEDLINE, EMBASE, and The Cochrane Library conducted a systematic research with combinations of the following keywords: (teaching OR education OR computer simulation) AND laparoscopy AND (gastric OR stomach OR colorectal OR colon OR rectum OR small bowel OR liver OR spleen OR pancreas OR advanced surgery OR advanced procedure OR complex procedure). Additional studies were searched in the reference lists of all included articles.
  
  
  RESULTS
  Fifty-four original studies were retrieved. Their level of evidence was low: most of the studies were case series and one fifth were purely descriptive, but there were eight randomized trials. Pig models and video trainers as well as gastric and colorectal procedures were mainly assessed. The retrieved studies showed some encouraging trends in terms of trainee satisfaction with improvement after training, but the improvements were mainly on the training tool itself. Some tools have been proven to be construct-valid.
  
  
  CONCLUSIONS
  Higher-quality studies are required to appraise educational value in this field.
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK; Center for Surgical Teaching and Research (CERC), Aix-Marseille Université, Marseille, France. Electronic address: laura.beyer@ap-hm.fr.
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Palter
authors.affiliation: Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Teodor
authors.initials: T
authors.lastname: Grantcharov
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, St. Mary's Campus, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000818:Animals; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods* / Q000639:trends; D004503:Education, Medical, Graduate / Q000379:methods / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D012985:Software Design; D013514:Surgical Procedures, Operative / Q000193:education