Single-Incision Laparoscopy: Training, Techniques, and Safe Introduction to Clinical Practice

Background: Single-incision laparoscopy is an emerging technique that brings new challenges to laparoscopy and introduces new skills that a surgeon must learn. The learning needs for single-incision skills acquisition are unknown and no current guidelines exist for training or for its safe adoption. Methods: We developed an approach to adoption of new surgical techniques and applied it to single-incision laparoscopy. It is based on the following principles: a defined training algorithm, dry and wet-laboratory practice, a graded clinical introduction, and careful review of early outcomes. We analyzed its impact in our initial 40 patients. Results: Our training paradigm consisted of the following: attending a formal course, developing a simulation model, and animal laboratory training, followed by graduated clinical adoption. A 20% conversion rate to standard laparoscopy or open surgery occurred. Conclusion: Introducing a new surgical technique may not only offer potential advantages but also present significant risks. We developed a thoughtful approach to adoption that includes simulation-based training, progressive clinical adoption, and early review of outcomes. This approach may be applied to various new clinical applications.