Practical Skills Acquisition Exercises

Laparoscopic intracorporeal suturing represents a difficult task in experienced hands. How then can the average urologist hope to obtain these skills and apply them whenever the situation calls for intracorporeal placement of sutures? There are two alternatives. You can either practice utilization of laparoscopic suturing skills or utilize any of the included short cuts discussed in this chapter. If your goal is to obtain skills that can be used time and time again for increasingly complex laparoscopic intracorporeal reconstructions, your time is better spent learning how to suture without opting for short cuts. This can be accomplished by spending time and money at courses or you can utilize simple equipment and practice inanimately at home, the office, or in the operating room. It sounds ridiculous to memorize the 12 steps that we presented in the previous chapter. This only represents a starting place for you to master the choreographed utilization of both of your hands. To do this you will require a camcorder and tripod. A tennis ball will serve as the targeted "organ" for reconstruction. You may utilize any suturing instruments or a disposable grasper that is available, or contact your local manufacturer's representative to borrow one. Cut sutures to a prescribed length and you can precede. Slow down first and try to get a feel for the instrument's tips motions. Once you get proficient at handling the needle make things progressively more difficult by covering your camera and tennis ball with a blanket. Finally, add a pelvic trainer (again, obtainable from a manufacturer's representative), trocars, and a plastic human pelvis (scale models are obtainable from many biological supply houses for under US$35). Your best bet is to keep both hands on either side of the camera, but as skills advance you should move to the side as is required for most animate applications. I have taken still photographs from a video recorder during just such a home-study course to demonstrate each step again. Every time you get frustrated, take a rest. Each time you start things should get easier. The hand-eye coordination to function in the videolaparoscopic environment will develop.

Katz recently described a simple method of training for performing the vesi-courethral anastomosis using chicken skin. A model urethra and bladder neck are prepared by folding and tabularizing a 5 X 4 cm piece of skin over a 14 French catheter. Training again is performed in a pelvic trainer. The single knot method of van Velthouven can be easily adapted to this training technique. As described by the authors, the initial attempts require the longest times for neophytes (residents and urologists with minimal laparoscopic experience). Needle passage was easier, followed by knotting and suturing in terms of skill acquisition. They noted in 10 neophytes who followed their five-step regimen, that all were able to advance and perform complete, accurate urethrovesical anastomoses (179).

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