In vitro training program to improve ambidextrous skill and reduce physical fatigue during laparoscopic surgery:...

We illustrate the preliminary experience with our planned intensive in vitro training program focused on the nondominant hand and reducing physical fatigue. Apart from this, we tried to calculate how much training is required for a novice urologist to master laparoscopic freehand suturing with the dominant and nondominant hands.

Between December 2001 and May 2002, one trainee worked on a Pelvi-trainer, first with the dominant (right) hand and then with the left hand, practicing intracorporeal suturing and cutting and improving physical endurance by gradually increasing the duration of each training session. Along with the Pelvi-trainer, he worked on left-handed writing to improve wrist movements. Before starting this training, he did not have any laparoscopic experience as assistant or primary surgeon. The progress was stored in the computer prospectively to compare the results with those obtained at the end of the training.

For the dominant hand, 30 hours over 2 months was required to master laparoscopic suturing skills. After training of the right hand, the nondominant hand required 40 hours of Pelvi-trainer work and 20 hours of handwriting during 2 months. Physical endurance for suturing in the Pelvi-trainer increased from 15 minutes to 150 minutes over 3 months. The main improvement was in the degree of pain over the right shoulder (because of the abducted position) and backache.

Incorporation of sufficient in vitro training to improve nondominant hand functioning and reduce physical fatigue can make adaptation to laparoscopic surgery easier.