Page 30 - Journal of Laparoscopic Surgery - WALS Journal

Ashish Saxena

Fig. 5: Images depicting the laparoscopic suturing practice

With further improvisation, newer exercises with models, and computerized or virtual reality devices were
increasing complexity can be designed and installed launched in the market. While detailed description of
in the simulator box to raise the level of challenge for these modalities is beyond the scope of this article, it is
trainees. With actual laparoscopic instruments, such as obvious that all of them require separate telescope, light
needle holder and Maryland forceps, trainees can also source, and monitor.
refine their suturing skills (Fig. 5). Further studies recognized that complicated function-
ing of operative tools degrades a surgeon’s performance,
DISCUSSION and extensive training is necessary to gain expertise in
Simulation is the imitation or modeling of a real-life handling a tool, thus validating the need of simulator-
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situation for training or instruction. It is an important based learning. 11,12
tool for the training of novices. It works largely by way While simulator training is suggested to be useful
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of a reduction in learning curve. One industry that has for acquiring psychomotor skills, these skills do not
largely benefited from the use of simulation technology transfer to the operation theater immediately. An actual
is aviation industry, where pilots have long been trained surgical experience under good supervision is necessary
to tackle real life-like scenarios before entering into the to increase the effectiveness of training. 13
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cockpit. Surgical endeavors are not much different from Considering the cost of commercially available
the aviation industry as both the fields demand high simulators, a number of low-cost alternatives have been
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levels of technical skill and allow small margins for error. developed using mirrors, digital camera, web camera, spy
The need for a simulation-based training program camera, etc., the cost of which varies from 43 to $116. 14
arose when surgeons found that their skills in open At an approximate cost of $3–4, smartphone-based
surgery did not transfer to the newer domain of simulation system devised by me is most economical
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laparoscopy. Principles of laparoscopic surgery became when compared to other low-cost simulators. The whole
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the subject of extensive research. Gallagher et al identified apparatus is constructed of nonexpensive material, such
a set of special skills that were deemed essential to perform as plastic box, ballpoint pens, rubber bands, etc., which
a laparoscopic procedure: (i) depth perception: the ability are easily obtainable. The practice materials do not get
to perform 3D maneuvers with a 2D view; (ii) adjustment consumed during sessions and need not be refurbished.
to fulcrum effect: to resolve the conflict between visual It is simple in its design, durable, and easy to assemble.
and proprioceptive feedback; (iii) hand–eye coordination; The maintenance cost is virtually zero.
(iv) bimanual manipulation; (v) handling of laparoscopic The smartphone is fixed in its slot while practicing
instruments; and (vi) ambidexterity: The ability to use both upon the apparatus, thus obviating the need of a
left and right hands with equal ease. camera-holding assistant. One can practice for long
Minimally, invasive surgery had already been ushered duration without being dependant on anybody else. The
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into the era of simulation-based training by Markman, smartphone slot can be rotated around a vertical axis to
when he introduced endoscopic simulation system focus upon different parts of the visual field. Interior
for proctosigmoidoscopy in 1969. Gradually, various of the box is coated with white color to maximize the
simulators, such as mechanical simulators, live animal illumination obtained from LED flash of smartphone.
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