Formal laparoscopic skills training: evaluation by surgical specialists in a health maintenance organization

The rapidly expanding field of laparoscopic surgery has required surgeons to adapt to a new operating environment. New procedures and techniques test the surgeon's skill and confidence. Supporting laparoscopic advances has required redesign of equipment and training. The latter often is presented in a step-by-step format related to a particular surgical procedure (e.g., laparoscopic cholecystectomy, laparoscopically assisted vaginal hysterectomy, etc.). The problems with this approach are the assumptions that the surgeon already possesses the necessary skills to perform fundamental surgical techniques in the new modality and that most participants enrolled in any given course will have a similar level of skill.