LAPAROSCOPIC SURGICAL TRAINING - EFFECTIVENESS AND IMPACT ON UROLOGICAL SURGICAL PRACTICE PATTERNS

Urological interest in laparoscopic surgical techniques has dramatical ly increased during the last several years. However, the extent to whi ch these methods are being used and the impact of training courses on clinical use are unclear. We assessed urologist practice patterns subs equent to a formal training course in urological laparoscopic surgery. On 5 dates between January and October 1991, a total of 163 urologist s participated in a 2-day, university sponsored, laparoscopic surgery training seminar. Instruction consisted of 8 hours of didactic lecture s including 2 live video cases, 4.5 hours of simulation and 4.5 hours in a live animal laboratory. Three months after the course the partici pants were mailed a questionnaire inquiring as to the interval laparos copic surgery experience. Practice demographics, additional training, equipment availability, number of laparoscopic surgery candidates iden tified, percentage of overall surgical case load, patient inquiries, c ases performed and complications were assessed by the questionnaire. D escriptive and correlative information was then derived from the data set. A total of 105 course participants (64%) responded to the questio nnaire and 64 had engaged in some form of additional training followin g the course. During the 3 months since course completion respondents had identified an average of 4 candidates for laparoscopic surgery, wh ich represented a mean of 2.5% of the total case load. Specific patien t inquiries averaged less than 1 per physician within 3 months. During this same interval respondents had performed a total of 156 laparosco pic procedures (1.7 per urologist). Of the participants 45% had not pe rformed their first case and 32% had performed more than 1 laparoscopi c procedure. A total of 11 complications was reported (7.2%) and in 7 instances the surgeon was required to convert to an open approach. Ver ess needle placement was perceived as the most difficult aspect of the technique (22% of the respondents). Training subsequent to the course was the best predictor of clinical use. Of those who responded 88% be lieved that their future use of laparoscopy would increase. This surve y suggests that subsequent to training, laparoscopic techniques are be ing rapidly and safely used by urologists. However, in the current sta te of development the impact of laparoscopic surgery on global urologi cal practice patterns appears to be small.