Training for laparoendoscopic single-site surgery (LESS)

Background: Laparoendoscopic single-site surgery (LESS) is a laparoscopic surgery in which a single small incision is made, associated with the use of a special device (single-port), or several small incisions grouped in one location (single-incision) are made, through which the laparoscopic trocars are inserted. The incision is made in the abdomen, preferably in the umbilicus. Certain peculiarities are noted in this approach, such as the difficulty, and sometimes the impossibility, of centering the image, the need to move both the camera and instruments together, requiring even more delicate and precise movements than in laparoscopy. Since information on training for LESS is scarce in the current literature, the authors report their experience with five different cases of this nature, performed in two porcine models, and then discuss a training plan for LESS. Methods: Five LESS procedures were performed in two pigs using different training techniques: two (one single-port and one single-incision) transumbilical laparoscopic cholecystectomies; one right-sided single-incision laparoscopic radical nephrectomy; one single-incision transumbilical laparoscopic radical nephrectomy; and one single-port transumbilical laparoscopic nephrectomy. Discussion: Different from what was observed in the transition from open surgery to laparoscopy, the Halstedian model should not be used in the teaching of LESS since this procedure requires that professionals partner together, thus requiring not only the training of surgeons, but of the whole team. Conclusion: LESS procedures are feasible and considered as further refinements in laparoscopic techniques. However, the peculiarities and difficulties inherent in these procedures require a specific training program combining theory and practice. The authors believe that this training is essential to achieve proficiency levels before the technique can be tried on human subjects. (C) 2009 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.