Spatial ability, experience, and skill in laparoscopic surgery.

BACKGROUND: Previous research showing correlations between spatial ability and surgical skills has used participants in relatively early stages of training. Research in skill acquisition has shown that the role of cognitive abilities can diminish as skills become increasingly automatic. In this study, we explored the role of spatial ability in laparoscopic surgical skills in two groups, one experienced and the other relatively inexperienced. METHODS: Subjects were recruited from two videoscopic courses: an advanced course for experienced surgeons and a laparoscopic urological surgery course attended by participants with relatively little laparoscopic experience. Three measures were obtained: spatial abilities, videoscopic experience, and operative skills. RESULTS: A significant correlation (r = 0.393) was found between spatial ability and skills in the lower experience group but not among the experienced surgeons (r = 0.020). CONCLUSIONS: The results are consistent with the prediction that the importance of spatial ability in performance of laparoscopic skills should diminish with experience.

Complete laparoscopic ileal cystoplasty.

INTRODUCTION: Laparoscopic enterocystoplasty provides a minimally invasive approach to bladder augmentation in the patient with a neurogenic bladder. In previously published reports, portions of the procedure were performed extracorporeally. We report our technique of complete intracorporeal laparoscopic enterocystoplasty. TECHNICAL CONSIDERATIONS: Important elements of the operation include (a) preoperative evaluation of patient compliance and videourodynamic studies; (b) cystoscopic placement of externalized ureteral stents; (c) transperitoneal placement of five radially dilating trocars; (d) identification of the cecum; (e) proximal mobilization of ileum sufficient for pelvic placement; (f) measurement of ileal length with segment of precut vessel loop; (g) vertical cystotomy after incising peritoneum and entering the space of Retzius; (h) ileal division and side-to-side anastomosis using endoscopic gastrointestinal anastomosis staplers; (i) detubularization and freehand intracorporeal suturing into a U-shaped configuration; (j) fixing ileal patch at the 6 and 11-o'clock positions; (k) completion of ileal-bladder anastomosis in quadrants with running sutures; (l) irrigation of bladder and placement of a closed suction drain in the pelvis; and (m) cystogram 4 weeks postoperatively. CONCLUSIONS: Pure laparoscopic enterocystoplasty is an advanced procedure that is technically feasible and yields excellent results, but has unproven benefits. We perform the entire operation intracorporeally with traditional instruments and do not rely on suturing devices or extracorporeal knots. Additional experience and technological developments may result in routine laparoscopic urinary augmentation and continent diversion.