Effectiveness of a hands-on training course for laparoscopic spine surgeryin a porcine model

Background: Although it is widely proposed that surgeons, before introducin g a novel laparoscopic technique in man, should practice in an appropriate animal model for acquisition of the necessary technical skills, the effecti veness of those hands-on training courses are rarely documented. Methods: In 1995 we have organized eight hands-on training courses for lapa roscopic anterior interbody spine fusion in an in vivo porcine model. A tot al of 72 colleagues from 50 different centers of 12 countries participated, including orthopedic, trauma, visceral, neuro-, and vascular surgeons. Qua lity and effectiveness of the course were evaluated by a questionnaire afte r a 1.5- to 2.5-year period. Results: During this time, 42.2% of the participating centers had applied t he new technique successfully in man. Centers which participated in the cou rse with a team that included a skilled laparoscopic surgeon and an orthope dic or trauma surgeon introduced the technique more frequently to clinical practice (57.9%) than those represented by only one participant (30.8%). Mo reover, there was a tendency toward a more frequent introduction of the tec hnique to clinical practice in centers associated with university hospitals (57.1% vs. 29.2%), indicating the requirement of a particular infrastructu re for this complex interdisciplinary procedure. Almost all participants (9 8.3%) agreed that for novel surgical techniques requiring advanced technica l skills, there should first be training in a large animal model before the technique is applied in man. Conclusions: Complex laparoscopic procedures (i.e., laparoscopic spine surg ery) can be successfully learned by in vivo hands-on training courses. We p ropose that for refinements and modifications of the technique (e.g., the l umboscopic approach), there should also first be training in a large animal model before these are applied in man.