Simulation in Minimal Access Surgery

Division of General Suigery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada 

The development of minimal access surgery (MAS) is one of the most important elements in the evolution of surgery in recent history. This unprecedented step in surgical technology has challenged our ability to teach the requisite cognitive and psychomotor skills. This chapter will deal with aspects related to the required upskilling. 

This chapter wiU discuss the development and role of different types of simulators in teaching MAS. We wiU discuss traditional box trainers, the use of virtual reality (VR), and efforts to standardize MAS training across the world. We will discuss the role of engineers in this process and how simulation may be used to enhance performance of both novices and experts through analysis of motion and force. Finally, we discuss how skills developed during simulation may be transferred to the operating room. 

A recent Cochrane Collaboration systematic review of the impact of laparoscopic box training on acquisition of laparoscopic skills found that in trainees with no previous laparoscopic experience, training on a laparoscopic box trainer improved time to task completion, decreased errors, and improved accuracy and overall performance when compared with trainees who received no simulation training [11]. 

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