Training in laparoscopic gynaecological surgery is challenged by the boundaries of the traditional apprentice-tutormodel and the ethical objective of limiting the complication rates. The European Academy for Gynaecological Surgery(The Academy) has focussed their scientific work in the last 6 years on defining the standards a future laparoscopistmust meet in order to operate, either independently or under supervision.
The Laparoscopic Skills Testing and Training (LASTT) model has been proved feasible and to have face andconstruct validity. Furthermore, it has been proved in this model that basic laparoscopic psychomotor skills (LPS)require proper training and that proficiency in those skills cannot be acquired by only training more complex tasks,such as intra-corporeal knotting. The observation that the LPS are retained over long periods is very important forthe structure of a training program, being therefore comparable to swimming or biking skills. The data gathered overthese years by the Academy, and supported by reports from other groups, strongly recommend that an in-house invitro model for training and testing laparoscopic skills should be available in every teaching centre. Only those whoreach proficiency in these practical skills, and who demonstrate sufficient theoretical knowledge, will have accessto the “Green Card” that defines the minimum requirements prior to training for surgical procedures with patients.Following this strategy, we postulate that the morbidity and mortality rate associated with laparoscopic proceduresin training centres will be reduced and the efficiency of one-to-one teaching will be improved.
