Low-Budget Laparoscopic Entry Simulation

The primary objective of this project is to develop a low-budget simulation model to supplement laparoscopic entry technique training.

The most common methods of laparoscopic entry are direct entry with optical trocar visualization, Veress needle insufflation before direct entry, and open entry using a Hasson trocar. There is no established method that is universally considered superior to the others, and similar outcomes are seen across all methods in terms of major adverse outcomes such as vascular or visceral injury. Therefore, surgeons have a responsibility to train on all types of laparoscopic entry. We designed a low-budget simulation that can be used to practice all three forms of common laparoscopic entry, with modifications to approximate entry at different sites, such as at the umbilicus compared with the left upper quadrant. A video demonstrating our simulation was developed and is available at https://youtu.be/4N4nhpbSPXg. Additionally, we developed a PowerPoint lecture designed to be used with our simulation, with an embedded pretest and posttest to gauge laparoscopic entry ability (Appendix 1, available online at http://links.lww.com/AOG/E27). We will continue to develop and study this model among military-training programs.

The low-budget laparoscopic entry simulation was developed using supplies purchased at local hardware stores. The reusable base costs approximately $24.48 to create. The entry technique model costs between $2.89 and $4.50 and can be used five times before requiring replacement. Our goal is to have urology, general surgery, and obstetrics and gynecology residents perform this simulation while collecting survey results on whether this simulation has aided surgical skills.

Laparoscopy is commonly used in many surgical procedures. Despite its diverse application throughout surgical fields, rates of associated visceral and bowel injuries remain a primary concern. These complications most commonly occur during initial abdominal entry. With potentially catastrophic complications that exist secondary to these intraprocedural injuries, surgical physicians have a duty develop proficiency in laparoscopic entry techniques before operating on patients. This low-budget laparoscopic entry simulation provides surgical learners a tool to develop these skills in a low-risk learning environment.