Laparoscopic Skill Training & Robotics

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Leroy Heinrichs, MD, PhD: It is my pleasure to introduce my colleague Dr. Lisolette Mettler, Professor of Gynecology and Obstetrics at Schleswig-Holstein, School of Medicine in Kiel, Germany. Lilo, tell me, on education, is laparoscopic skills training really important?

Lisolette Mettler, MD, PhD: Thank you for the question, it is a pleasure to give an opinion. I have been doing laparoscopic surgery, I would say, since 1972. That is along time. At that time we were doing the work directly on the patient. Now this has gradually changed, we have had different possibilities to train before, just very, very simple trainers, we call them laparoscopic trainers or pelviscopic trainers. Very simply we looked through a glass model and did our exercises under sight, suturing, and the moving of the instruments and to know how to handle laparoscopic instruments. And we covered this and looked through a spy, so to say, with one eye. We then bring the laparoscopic surgery that we did in those days not only on the screen but looking with one eye.

Leroy Heinrichs, MD, PhD: That has changed a little bit.

Lisolette Mettler, MD, PhD: That has changed since 1986 since we have something that is called video laparoscopy. Then we changed that onto the model on the video screen. Now these very similar models are still helpful because they help us to do hand/eye coordination. They help us to move the left hand to the right hand, to get depth perception, to find out how we can do suturing, how we can take extraction, how we can do cutting, how we can take electric lines and separate tissue. But recently, I would say within the last ten years, these simple models have been supplemented by what we call laparoscopic skill trainers, like the LTS2000. There is a possibility to do the exercises in a certain order on the video screen, nothing smuggling through, just looking on the video screen in a couple of positions, standing or sitting, and imitating real surgical procedures like myomectomy, ectopic pregnancies, appendectomy, putting loops in, tying, all these exercises can be done on skill trainers. I think that laparoscopic skill training is absolutely necessary today for medical students to get a feeling that they can do surgery if they are really, besides their brain, which of course they can practice and to show they can do manual exercises if they want to be surgeons.

Then for residents, when they are in residential training, they have to it before they go on to the patients, and of course for older surgeons, continued assessment of what we manually can still do. How our brain, our thoughts are interacting with the hand.

So, I think skill training as it is offered nowadays at conferences, in medical schools, in the industries, it is essential in our surgical planning and our surgical work. To a more extreme side, we have to preplan the surgery, possibly with images from MRI, from ultrasound, how we set the way, how we can enter the trocars, and how we can best get at our target. All these kinds of things are given to us by what we call hysteroscopic/laparoscopic skill training.

Leroy Heinrichs, MD, PhD: Tell me Lilo, how important are the metrics; the measurements that the machines make about performance. Is that important?

Lisolette Mettler, MD, PhD: The metrics are very important, because without evaluation we cannot see how these exercises get better and better. So, they are of extreme importance.

Just to finish the picture, nowadays we also have possibilities to do these exercises in the virtual space. That is something that is not cadaver work, which we also do sometimes. It is very costly and very difficult to do, ethically. We also have the possibility to work on sheep, or sheep organs but for me, the best choice is working in virtual space on things, surgical things, like the flight pilots in virtual space image; imaging exercises that we have to do on our patients. That is the optimal planning for practical surgery that we have to implement in the future. To think in a way that we can do our exercise on the computer, at home, in the evening, relaxing and have a good time, a glass of wine with it or whatever and you enjoy the exercise on a computer. I think that is going to come.

Leroy Heinrichs, MD, PhD: Thank you very much for that opinion. I completely agree.

Lisolette Mettler, MD, PhD: I do hope that laboratory skill training is taken seriously by all our medical colleagues and it is being used from the younger generation to the older generation because the older generation has to test their ability if they are still able to do these kinds of surgeries.

Leroy Heinrichs, MD, PhD: Thank you.