Skills training and the role of skills centres

Authors


Sir,

We agree with the view of Davies and Hamdorf [1] that the introduction of new techniques in surgery requires an approach that is commensurate with modern medicine. The old dictum ‘see one, do one, teach one’ is unacceptable in modern medical practice, ethically and medicolegally. Laparoscopic surgery requires a different set of spatial skills than for open surgery. The authors advocate using virtual reality simulators set in specially developed centres, i.e. virtual mini-hospitals [1]. Virtual reality is a promising technology, although hard evidence for its benefit in surgery and urology is not yet available and likely to take at least 5–10 years before trials are complete [2]. We propose a simple ‘kitchen table’ laparoscopic trainer (Fig. 1). This is a modern equivalent of knot-tying on the back of a chair in the surgeons’ room and requires no special equipment that is not available to any hospital-based urologist.

Figure 1.

Figure 1.

The components of the simple trainer: (1) laptop computer; (2) direction of port insertion; (3) web camera; (4) light source; (5) an object for manipulation; (6) the box.

The requirements are a laptop computer with web camera connected to it serves as the video unit. The web camera is placed along with a light source in a box of ≈ 1.5 m by ≈ 1 m. Several laparoscopic ports are introduced through the top surface of the box and manipulating the laparoscopic instruments can be practised inside the box while looking at the computer screen, which shows the real-time image transmitted from the web camera. We hope to enhance our performance on this computer trainer before we are assessed on one of the virtual reality simulators in the skills laboratory [3].

Ancillary