In the old days, one could refine surgical technique with just sutures and a board of styrofoam. Now, in order to learn laparoscopy, interns and residents have to use super-expensive simulators to which most hospitals don’t even have access. So even though laparoscopy is known to offer many advantages over open procedures, many surgeons still don’t feel comfortable with it. The problem isn’t, of course, that laparoscopy itself is hard, but that getting decent practice is so difficult. 

The most well-to-do surgical departments usually have high-end simulators like LapSim, Lap Mentor, or Verefi. These are computer-based tools that offer three-dimensional renderings of surgical fields, which the user manipulates using special laparoscopic instruments that communicate with the computer over a USB connection. This video, from the Surgical Science website, shows the LapSim in action:

In this video Carol Lake, the CEO of Verefi, shows us her company’s trainer: 

The major advantage of these systems is that they can recreate any situation or procedure, affording trainees a rather broad experience. Moreover, the simulated images can be modified for the sake of guidance; in the above picture, for example, the section of vessel that is supposed to be cut has been colored bright green. Finally, because the entire experience is computerized, every aspect of the individual’s performance is logged, which allows residency directors to monitor individual students and track improvement over time.

Although shortcomings include the lack of haptic feedback, as well as the fact that trainees are not using actual laparoscopic instruments, the major disadvantage of these systems is their extremely high cost (near or above $100,000).

A new class of surgical trainers, however, offers a more stripped-down experience at a significantly lower cost. The EZ Trainer from LapEd, for example, allows the user to practice laparoscopic technique using a camera that plugs into his or her own laptop.

The device resembles a briefcase when closed; when open, the user introduces laparoscopic instrumentation onto the practice stage through the front side of the case, which also contains the camera and blocks direct visualization.

The biggest advantage of the EZ Trainer is that it costs only $970, which means that most labs and even individuals should be able to afford it. Being able to practice at home, on one’s own time, may be extremely liberating to those who would otherwise be trapped in a laboratory all night using an expensive simulator.

Unlike those simulators, however, this device cannot recreate complicated exercises and, of course, cannot track an individual’s performance. Moreover, it requires the user to have his or her own laptop, which may be a problem for some.

The LapTrainer from Simulab is another device in this class, although it is less portable and costs $1800:

There’s really no great solution yet: if you want all of the features, you’re going to pay a hefty, perhaps even prohibitive price.

Certainly, if your program can afford it, it’s worth getting a high-end simulator for the laboratory; however, for at-home or on-the-go practice, and for less affluent programs, devices like the EZ Trainer are probably a better bet.

(Full disclosure: Dr. Jaime Landman, the medical director of this site, is part of the team that developed the EZ Trainer.)