title: [Pyramid training model in laparoscopic surgery].
abstract: BACKGROUND
  Minimally invasive surgery implementation requires a regulated and orderly learning process.
  
  
  METHODS
  Jesús Usón Minimally Invasive Surgery Centre promotes a pyramid training model structured into four levels: training of basic and advanced skills in physical simulator (level 1), training of anatomical protocols and advanced skills with animal models (level 2) training advanced procedural skills with tele-surgical applications (level 3), and training in the operating room (level 4). Training provided at levels 1 and 2 is described and evaluated.
  
  
  RESULTS
  4284 participants have been trained in laparoscopy at our institution. 95.5% surgeons: 49% gastroenterologists, 30% urologists, and 14% gynecologist (14%). 77% of celebrated courses consisted of 20 hours training (8 at level 1 and 12 at level 2). 94.37% of participants considered pyramid model as highly suitable, scoring 9.5 on a scale 1-10 for the model and for the simulation quality. 82.7% perceived the improvement in their laparoscopic skills and 99.56% recommend this training program to other surgeons.
  
  
  CONCLUSIONS
  There are no unified criteria between different training programs but most of them measure laparoscopic skills based on time of execution, quality or mistakes of the exercise, and the student satisfaction test.
  
  
  CONCLUSIONS
  The pyramid training model lead to the acquisition of necessary laparoscopic skills to perform safely advanced minimally invasive techniques.
authors.affiliation: Unidad de Laparoscopia, Centro de Cirugía de Mínima Invasión Jesús Usón, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Usón-Gargallo
authors.affiliation: Unidad de Cirugía. Facultad de Veterinaria de la Universidad de Extremadura, Cáceres, Spain.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Pérez-Merino
authors.affiliation: Unidad de Cirugía. Facultad de Veterinaria de la Universidad de Extremadura, Cáceres, Spain. jmuson@unex.es.
authors.forename: Jesús María
authors.initials: JM
authors.lastname: Usón-Casaús
authors.affiliation: Unidad de Laparoscopia, Centro de Cirugía de Mínima Invasión Jesús Usón, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sánchez-Fernández
authors.affiliation: Unidad de Laparoscopia, Centro de Cirugía de Mínima Invasión Jesús Usón, Spain.
authors.forename: Francisco Miguel
authors.initials: FM
authors.lastname: Sánchez-Margallo
mesh_terms: D000818:Animals; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003198:Computer Simulation; D003258:Consumer Behavior; D003479:Curriculum; D004501:Education, Medical / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000295:instrumentation / Q000379:methods; D059032:Learning Curve; D008953:Models, Anatomic; D023421:Models, Animal; D008962:Models, Theoretical; D010820:Physicians / Q000523:psychology; D011597:Psychomotor Performance; D013030:Spain; D013043:Specialties, Surgical / Q000193:education* / Q000379:methods; D013525:Surgical Instruments; D017216:Telemedicine / Q000379:methods
keywords: destreza en laparoscopia; enseñanza en laparoscopia; evaluación estructurada.; laparoscopia; laparoscopic skill; laparoscopic teaching; laparoscopy; structured assessment