“Self-Designed Simulation-Based Laparoscopic Training Program for Urology Residents: Results After 6 Years of Experience”

Figures & data

Table 1 Index of Theoretical Contents of the On-Line Course

Title	Contents
1. Introduction	Historical development of laparoscopy in surgery and in Urology. Milestones in laparoscopic surgery in Urology Difficulties in learning laparoscopy. New learning model base on simulation.
2. The operating room in laparoscopic surgery	General basic organization of the operating room to perform laparoscopic surgery. Ergonomics in laparoscopy. Basic instruments and complementary materials in laparoscopy.
3. Starting surgery.	Patient positioning for laparoscopic surgery. Initiating pneumoperitoneum: Veress needle. Hasson’s technique. Hand-assisted laparoscopy.
4. Pathophysiology of pneumoperitoneum	Effects on physiology: Ventilatory Hemodynamics Perfusion of abdominal organs Intracranial pressure Hormonal, metabolic and immune system effects
5. Laparoscopy in special situations	Performing laparoscopy in: Morbid obesity Previous abdominal surgery Pelvic fibrosis Visceromegaly Ascites Pregnancy Hernias Aneurysms
6. Complications in laparoscopic surgery	Potential complications and their resolution: Creation of pneumoperitoneum Insufflation and pneumoperitoneum Of the surgical procedure itself In the removal of the trocars
7. Bibliography	Reference and must-read articles

Figure 1 Residents participating in the FJDUH laparoscopic training program.Top right: E-BLUS “circle cut” exercise. Bottom right: practice on the E-BLUS “peg transfer” exercise on a pelvic trainer. Left: surgical simulation day on a porcine model in the FJDUH experimental operating room. Residents have given authorization to publish the pictures.

Figure 2 Total exercises in each edition of the E-BLUS exam. Exercises passed in each edition according to year of residency. Exercises in which execution time is improved compared to the previous edition.

Figure 3 Total exercises passed in the E-BLUS examination (5 exercises evaluated): FJDUH (left side) Vs last year residents from hospitals without standardized LAP training program visiting our service during the study period (right side).

Table 2 Survey: Anonymous Online Evaluation Questionary Fulfilled by All Residents’ Participants

Question	Contents
1. General evaluation of the program	0	1	2	3	4	5
2. General evaluation theoretical contents of the course	0	1	2	3	4	5
3. Theoretical course: Evaluate the most valuable chapters	Enumerate
4. Did the program made you increase your practices at the box-trainer?	No Yes, but just when the exam was close Yes, but irregularly Yes, all year through
5. Which of these basic skills you improved the most?	Eye-hand coordination Bi-manual coordination Suture technique 3D orientation Clipping and cutting technique
6. Did the program facilitate your basic LAP skills acquisition?	Yes, definitely as much I practiced more I improved Yes, my skills improved, but it was due to the combination of practice, other courses and everyday surgical practice No, I did not feel any modification on my learning curve No, in any way.
7. Estimate hours/month (h/m) of box practice during your residency	0–5 h/m 5–10 h/m 10–15 h/m >15 h/m Variable through the year
8. What is your opinion about EBLUS exercises and exam?	EBLUS is a goal. It should be mandatory before acquiring Urologist certification, no matter your area of expertise. EBLUS is a goal. Warranties that you have the skills for LAP surgery. EBLUS is the way to stimulate practice and acquire skills for a save LAP procedure. But that does not mean that you know how to perform LAP surgery. EBLUS is useless
9. Experimental surgery practices: express your opinion	Are a complement for skills acquisition in a near to clinical scenario. Are expendable but are interesting to do I feel more confident if I have done a certain procedure on the experimental OR before I try it with a patient. It is an essential tool to improve my surgical technique Not interesting at all I prefer doing experimental OR practices outside my hospital