Urologists' open skills benefit from laparoscopy training

Shanghai, China-A majority of urologists feel that laparoscopic training has had a positive effect on their current open surgical skills, including those involving radical prostatectomy, according to research presented at the 2008 World Congress of Endourology & SWL.

While the effect of an intensive training program on laparoscopic surgical skills is well documented, very little data currently exist on the effect of such training on open operative skills.

Among the included surgeons, 41 completed the questionnaire. A significant finding was that the majority of responders (97%) felt that laparoscopic training had a positive effect on their current open surgical skills. More specifically, the positive influence of minimally invasive surgery was an increase in open operative confidence, instrument precision, and careful tissue dissection. Such details were observed by 43%, 71%, and 23% of the trainees, respectively.

With respect to anatomic landmark identification and delicate tissue handling, 94% of the respondents felt that laparoscopic training has influenced their confidence and technique.

"The greatest increase in confidence rates was reported in identification, handling, and dissection of the neurovascular bundles during radical prostatectomy," first author Ali Gözen, MD, associate professor of urology at SLK Kliniken Heilbronn, told Urology Times. "While improvements were noted for retroperitoneal renal surgery, particularly for the renal vasculature, the greatest improvement in subjective performance among the respondents was reported for more precise nerve-sparing radical prostatectomy."

The researchers' data help demonstrate that, among other patient-related benefits, laparoscopic training can increase surgeon confidence with concomitant improvement in open surgical technique. Such results would reassure current and future urology residents, where continued application of minimally invasive approaches (both standard and robot-assisted laparoscopy) have largely reduced open abdominal and pelvic procedures.

Over the last decade, many have questioned whether residents are receiving the necessary exposure and experience for open procedures. The University of Heidelberg group has provided some preliminary data that anatomic exposure during laparoscopy, with reduced blood loss and magnified vision, coupled with a more systematic approach to the procedure, will ultimately complement and facilitate open surgical skills.