A didactic model in laparoscopic surgery: the usefulness of endotrainers.

Literature data show as operative time and incidence of complication after laparoscopic surgery are strictly related with the training and the experience of surgeons. During a correct formative path for minimal-invasive surgeons, the training using simulators is mandatory because it permits to get practice in new techniques and to familiarize with unusual and developing equipments and instruments from which depends the correct execution of surgical procedures.The Authors present a didactic model of training in laparoscopic surgery using endotrainers. The simulators are shaped to reproduce the abdominal cavity and their top is a membrane useful to carry out pneumoperitoneum and trocars introduction. In the inner, synthetic anatomical models or animal organs can be used to reproduce the main steps of surgical procedures avoiding the use of living animals; it permits to elude the bureaucratic and economic limits related to the use of them. Besides exercises based on the use of ordinary objects as peas and beans, rubber bands or matches are useful to develop the basic gesture, the orientation in a bi-dimensional space and the eye-hand coordination. These exercises are prevalently directed to inexperienced surgeons at the beginning of a training program.In this video is presented a consecutive series of exercises which represents the progression of a training program in laparoscopy beginning from easy “games”, going through procedures of increasing difficulty and finishing with performing the most complex surgical steps. In particular, exercises performed on anatomic models permit to reproduce the main steps of abdominal and pelvic surgery and the use of the same instrumentation utilized in the operating room, allow to obtain the necessary technical competence. The aim of the program is to progressively acquire the right coordination and accuracy in the bimanual gestures and suturing and knotting techniques. The described exercises want to be a incentive for the diffusion of the use of simulators in the training programs for residents and inexperienced surgeons even if the use of endotrainers can be costructive every time. It represent a helpful support to further improve the training in laparoscopic techniques, shortening the learning curve and reducing operative times and complications.