As the urologists at the University of Iowa showed in their classic 1999 paper, five years after a two day training course, only 54% of attendees were continuing to perform laparoscopy despite an early higher "take" rate. The question thus arises, will a more intensive approach, both in instruction and duration, have a more lasting effect. This review of the initial 32 urologists going through the week-long one-on-two (i.e. one instructor to two attendees) mini-residency program at the University of California - Irvine, showed that 8 months later, 81% of the attendees were practicing more complex laparoscopic surgery (e.g. radical nephrectomy, nephroureterectomy, and/or pyeloplasty); of note, many had begun to favor standard laparoscopy over the hand-assist approach. Whether this will continue at 5 years is uncertain, but I believe, given the current demand for laparoscopic procedures, it likely will. To my mind, this experience calls out for the establishment of several regional training centers at which urologists can learn new techniques in a full service environment that can provide the necessary animate and inanimate models, surgical cases for observation, and most importantly of all, a dedicated teaching staff to guide and instruct in a one-on-one manner and a willingness to proctor at the attendee's hospital as requested. While the expense for programs of this nature is substantial, the cost of ignoring the need is far higher both in dollars and human kind.

Corica FA, Boker JR, Chou DS, White SM, Abdelshehid CS, Stoliar G, Sala LG, Shanberg AM, Clayman RV, McDougall EM

J. American College of Surgeons 203(5): 692-698

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Laparoscopic & Robotic Section

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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