Laparoscopy Training Courses in Urology

The history of laparoscopic surgery began with man’s attempts to inspect concealed areas of the body. Early endoscopy from Bozzini’s “lichtleiter” in 1805 to the development of modern cystoscopy by Nitze in the late 1800s helped develop the optical tools required for laparoscopy. The early 1900s saw the birth of laparoscopy with Kelling, a surgeon from Dresden, describing the technique of celioscopy in dogs and Jacobaeus from Sweden reporting two cases of thoraco-laparoscopy in which he used a trocar to create pneumoperitoneum in humans and then inserted a cystoscope. Kurt Semm, an engineer and gynecologist helped develop many of the other tools associated with laparoscopy including an automatic insufflation device that monitored gas flow and intra-abdominal pressure, thermocoagulation for use during the procedure as well as many early laparoscopy instruments. (Gomella & Strup, 1994) The first laparoscopic nephrectomy was performed by Clayman and colleagues in 1990. (Clayman et al., 1991) With improvements and refinement of the technology, the first laparoscopic living donor nephrectomy soon followed. (Ratner et al., 1995) In 1997, Nakada and colleagues, performed the first hand-assisted laparoscopic nephrectomy (HALN) with a sleeve in the United States. (Nakada et al., 1997) By placing a hand in the abdomen, the HALN provided urologists tactile sensation and helped decrease the learning curve for laparoscopy. (Gaston KE et al., 2004) The hand-assisted approach also allowed older urologists that had not been trained in laparoscopy to begin to perform laparoscopic cases and helped bridge the gap from open surgery and a pure laparoscopic approach. (Munver R et al., 2004) With the rapid advances in technology in the field of urology, post-graduate training courses are important to help bridge the technology gap for current practicing urologists. The development of newer high-fidelity simulators and metrics for assessing laparoscopic skill acquisition are essential in order for us to better teach laparoscopic surgery.