Laparoscopy and Robotics Skills-based Laparoscopy Training Demonstrates Long-Term Transfer of Clinical Laparoscopic Practice: Additional Follow-up Gyan Pareek, Sean P. Hedican, Jay T. Bishoff, Steven J. Shichman, J. Stuart Wolf Jr., and Stephen Y. Nakada OBJECTIVES The American Urological Association Hands on Laparoscopy course was designed to help practitioners without laparoscopic training advance their skills. We evaluated the long-term effect of this course on urologists’ practice. METHODS A total of 52 urologists, 37-61 years old (mean 50.7), participated in one of three courses given from August 2002 to October 2003. The 2-day course included performing standardized tasks with videotape analysis and participating in porcine and pelvic trainer laboratory sessions with intense mentoring from known experts. Surveys were sent by regular and electronic mail in February 2007 to assess the effect of the course. The mean follow-up was 48 months (range 41-55). RESULTS Of the 52 surveys mailed, 32 were returned (61%). Most respondents were in private practice and had previous experience with extirpative urologic laparoscopy. Of the 32 respondents, 31 (97%) reported that their laparoscopic practice had expanded after taking the course. Also, 24 (75%) reported having sutured laparoscopically after taking the course, with 61% having sutured a bleeding vessel, and 80% reported that the video mentoring during the course was helpful. Of those who purchased a pelvic trainer, 90% reported practicing on it regularly. CONCLUSIONS The results of our study have shown that the Hands on Laparoscopy course has a significant long-term (mean 48 months) effect on the laparoscopic practice of course alumni. The experi- ence gained from skills-based lectures, videotape analysis of pelvic trainer performance, and a mentored porcine laboratory session resulted in most participants expanding their practice (97%) and suturing laparoscopically (75%). UROLOGY 72: 265–267, 2008. © 2008 Elsevier Inc. S ince the introduction of laparoscopic nephrectomy in 1991 by Clayman et al., 1 urologists have em- braced laparoscopic renal surgery as a first-line approach in most scenarios. Recent trends have ex- panded laparoscopic applications to include reconstruc- tive procedures, including pyeloplasty and radical prosta- tectomy. The laparoscopic skills required to perform the various procedures have traditionally been learned during advanced fellowship training. Recently, postgraduate courses have become widely available and have offered an alternative method for urologists to incorporate min- imally invasive techniques into their practice. The dura- bility and long-term effect of these courses has been questioned by some investigators. 2 Specifically, studies have shown that urologists who acquire skills from courses fail to maintain these techniques in their daily practice. 2-4 We sought to evaluate the long-term effect of the American Urological Association Hands on Laparos- copy (HOL) course on the clinical practice of the par- ticipants, with the hypothesis that skills-driven learning would lead to increased rehearsal, clinical skills, and practice expansion. MATERIAL AND METHODS A total of 52 urologists, 37-61 years old (mean 50.7), partici- pated in one of three courses given from August 2002 to October 2003. The curriculum and faculty for these courses were the same. None of the urologists had performed significant laparoscopic suturing clinically before taking the course. The 2-day course included didactic lecture sessions, performing stan- dardized tasks with expert videotape analysis, and participation in a porcine and an extended pelvic trainer laboratory session. The didactic segment of the course covered diagnostic eval- uation techniques and potential intraoperative and postopera- tive complications. Specifically, the techniques of dissection and step-by-step instructions for suturing were prominent in the From the Department of Surgery, Division of Urology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Surgery, Division of Urology, University of Wisconsin Medical School, Madison, Wisconsin; Department of Urology, Intermountain Health Care, Salt Lake City, Utah; Connecticut Surgical Group, Hartford Hospital, Hartford, Connecticut; and Department of Urology, Uni- versity of Michigan Medical School, Ann Arbor, Michigan Reprint requests: Stephen Y. Nakada, M.D., Department of Surgery, Division of Urology, G5/339 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792. E-mail: nakada@surgery.wisc.edu © 2008 Elsevier Inc. 0090-4295/08/$34.00 265 All Rights Reserved doi:10.1016/j.urology.2008.03.038