Skip to main content
SpringerLink
Log in

Teaching Advanced Laparoscopic Skills in Colorectal Surgery

  • Chapter
Training in Minimal Access Surgery

  • 808 Accesses

Abstract

Laparoscopic colon and rectal surgery is now well established as a safe and effective technique for treating many conditions. The development of a standard platform and tools for training laparoscopic skills is crucial, since a specific set of skills is necessary to perform laparoscopic surgery. Time, cost and medico-legal constraints have led to a fall-back of laboratory-based skill acquisition, which provides for a structured and systematic educational opportunity, in addition to stress modulation. However, multiple inanimate models and virtual reality simulators indicate that there is no single best method, which has high fidelity for transfer of skills from bench to operating room. The most important type of training is acquired from high volume structured experience in formal laparoscopic colorectal surgery training programs.

Fellowship training provides an opportunity for the trainee to recognize and implement careful patient selection, adequate exposure and safety in the operating room, video analysis and immediate feedback with respect to operative performance and postoperative outcomes. This form of training shortens the proficiency gain curve and produces competent surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp. 1904;15:267–76.

    Google Scholar 

  2. Bergamaschi R. Farewell to “see one, do one, teach one”? Editorial Surg Endosc. 2001;15:637.

    Article  Google Scholar 

  3. Figert PL, Park AE, Witzke DB, Schwartz RW. Transfer of training in acquiring laparoscopic skills. J Am Coll Surg. 2001;193(5):533–7.

    Article  CAS  PubMed  Google Scholar 

  4. Gallagher AG, Al-Akash M, Seymour NE, Satava RM. An ergonomic analysis of the effects of camera rotation on laparoscopic performance. Surg Endosc. 2009;23(12):2684–91.

    Article  PubMed  Google Scholar 

  5. Bergamaschi R, Dicko A. Instruction versus passive observation: a randomized educational research study on laparoscopic suture skills. Surg Laparosc Endosc Percutan Tech. 2000;10(5):319–22.

    CAS  PubMed  Google Scholar 

  6. Uchal M, Haughn C, Raftopoulos Y, Hussain F, Reed JF, Tjugum J, Bergamaschi R. Robotic camera holder as good as expert camera holder: a randomized crossover trial. Surg Laparosc Endosc Percutan Tech. 2009;19(3):272–5.

    Article  PubMed  Google Scholar 

  7. Arora S, Sevdalis N, Aggarwal R, Sirimanna P, Darzi A, Kneebone R. Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc. 2010;24(10):2588–93. Epub 2010 Mar 31.

    Article  PubMed  Google Scholar 

  8. Haluck RS, Krummel TM. Computers and virtual reality for surgical education in the 21st century. Arch Surg. 2000;135(7):786–92.

    Article  CAS  PubMed  Google Scholar 

  9. Schmidt RA. Processing information and making decisions. In: Motor learning and performance. Champain: Human Kinetics Publishing; 1991. p. 26–8.

    Google Scholar 

  10. Reznick RK, MacRae H. Teaching surgical skills–changes in the wind. N Engl J Med. 2006;355(25):2664–9.

    Article  CAS  PubMed  Google Scholar 

  11. Fitts PM, Posner MI. Human performance. Belmont: Brooks/Cole; 1967.

    Google Scholar 

  12. Kaufman HH, Wiegand RL, Tunick RH. Teaching surgeons to operate–principles of psychomotor skills training. Acta Neurochir (Wien). 1987;87(1–2):1–7. Review.

    Article  CAS  Google Scholar 

  13. Aggarwal R, Darzi A, Grantcharov TP. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248(4):690–1; author reply 691.

    Article  PubMed  Google Scholar 

  14. Mahmood T, Darzi A. The learning curve for a colonoscopy simulator in the absence of any feedback: no feedback, no learning. Surg Endosc. 2004;18(8):1224–30.

    Article  CAS  PubMed  Google Scholar 

  15. Rogers DA, Regehr G, Howdieshell TR, Yeh KA, Palm E. The impact of external feedback on computer-assisted learning for surgical technical skill training. Am J Surg. 2000;179(4):341–3.

    Article  CAS  PubMed  Google Scholar 

  16. Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery. 2007;141(4):442–9.

    Article  PubMed  Google Scholar 

  17. Uchal M, Tjugum J, Martinsen E, Qiu X, Bergamaschi R. The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial. Am J Surg. 2005;189(6):753–7.

    Article  PubMed  Google Scholar 

  18. Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg. 2006;244(3):400–9.

    PubMed Central  PubMed  Google Scholar 

  19. Barnes RW, Lang NP, Whiteside MF. Halstedian technique revisited. Innovations in teaching surgical skills. Ann Surg. 1989;210(1):118–21.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Rosser JC, Rosser LE, Savalgi RS. Skill acquisition and assessment for laparoscopic surgery. Arch Surg. 1997;132(2):200–4.

    Article  CAS  PubMed  Google Scholar 

  21. Uchal M, Raftopoulos Y, Tjugum J, Bergamaschi R. Validation of a six-task simulation model in minimally invasive surgery. Surg Endosc. 2005;19(1):109–16.

    Article  CAS  PubMed  Google Scholar 

  22. Jones MB, Kennedy RS. Isoperformance curves in applied psychology. Hum Factors. 1996;38(1):167–82.

    Article  CAS  PubMed  Google Scholar 

  23. Palter VN. Comprehensive training curricula for minimally invasive surgery. J Grad Med Educ. 2011;3(3):293–8.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG. Proving the value of simulation in laparoscopic surgery. Ann Surg. 2004;240(3):518–25; discussion 525–8.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondré K, Stanbridge D, Fried GM. A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg. 2005;190(1):107–13.

    Article  PubMed  Google Scholar 

  26. Vassiliou MC, Ghitulescu GA, Feldman LS, Stanbridge D, Leffondré K, Sigman HH, Fried GM. The MISTELS program to measure technical skill in laparoscopic surgery: evidence for reliability. Surg Endosc. 2006;20(5):744–7.

    Article  CAS  PubMed  Google Scholar 

  27. Jordan JA, Gallagher AG, McGuigan J, McGlade K, McClure N. A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition. Am J Surg. 2000;180(3):208–11.

    Article  CAS  PubMed  Google Scholar 

  28. Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM. Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. Am J Surg. 2010;199(1):115–20.

    Article  PubMed  Google Scholar 

  29. Datta V, Bann S, Aggarwal R, Mandalia M, Hance J, Darzi A. Technical skills examination for general surgical trainees. Br J Surg. 2006;93(9):1139–46.

    Article  CAS  PubMed  Google Scholar 

  30. Satava RM. Identification and reduction of surgical error using simulation. Minim Invasive Ther Allied Technol. 2005;14(4):257–61.

    Article  PubMed  Google Scholar 

  31. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004;91(2):146–50.

    Article  CAS  PubMed  Google Scholar 

  32. Lee JY, Mucksavage P, Kerbl DC, Osann KE, Winfield HN, Kahol K, McDougall EM. Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery. J Endourol. 2012;26(5):545–50.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Bridges M, Diamond DL. The financial impact of teaching surgical residents in the operating room. Am J Surg. 1999;177(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  34. Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg. 2007;246(5):771–9.

    Article  PubMed  Google Scholar 

  35. Neary PC, Boyle E, Delaney CP, Senagore AJ, Keane FB, Gallagher AG. Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons. Surg Endosc. 2008;22(10):2301–9.

    Article  PubMed  Google Scholar 

  36. LeBlanc F, Champagne BJ, Augestad KM, Neary PC, Senagore AJ, Ellis CN, Delaney CP, Colorectal Surgery Training Group. A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg. 2010;211(2):250–5.

    Article  PubMed  Google Scholar 

  37. Essani R, Scriven RJ, McLarty AJ, Merriam LT, Ahn H, Bergamaschi R. Simulated laparoscopic sigmoidectomy training: responsiveness of surgery residents. Dis Colon Rectum. 2009;52(12):1956–61.

    Article  PubMed  Google Scholar 

  38. Cesanek P, Uchal M, Uranues S, Patruno J, Gogal C, Kimmel S, Bergamaschi R. Do hybrid simulator-generated metrics correlate with content-valid outcome measures? Surg Endosc. 2008;22(10):2178–83. Epub 2008 Jul 12.

    Article  PubMed  Google Scholar 

  39. Milsom JW, Böhm B, Decanini C, Fazio VW. Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model. Surg Endosc. 1994;8(9):1117–23.

    Article  CAS  PubMed  Google Scholar 

  40. Giger U, Frésard I, Häfliger A, Bergmann M, Krähenbühl L. Laparoscopic training on Thiel human cadavers: a model to teach advanced laparoscopic procedures. Surg Endosc. 2008;22(4):901–6. Epub 2007 Aug 18.

    Article  PubMed  Google Scholar 

  41. Ross HM, Simmang CL, Fleshman JW, Marcello PW. Adoption of laparoscopic colectomy: results and implications of ASCRS hands-on course participation. Surg Innov. 2008;15(3):179–83.

    Article  PubMed  Google Scholar 

  42. Pattana-arun J, Udomsawaengsup S, Sahakitrungruang C, Tansatit T, Tantiphlachiva K, Rojanasakul A. The new laparoscopic proctocolectomy training (in soft cadaver). J Med Assoc Thai. 2005;88 Suppl 4:S65–9.

    PubMed  Google Scholar 

  43. Sharma M, Horgan A. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg. 2012;36(8):1732–7.

    Article  PubMed  Google Scholar 

  44. Iordache F, Bucobo JC, Devlin D, You K, Bergamaschi R. Simulated training in colonoscopic stenting of colonic strictures: validation of a cadaver model. Colorectal Dis. 2015;17(7):627–34. doi:10.1111/codi.12887.

  45. Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ. A systematic review of skills transfer after surgical simulation training. Ann Surg. 2008;248(2):166–79.

    Article  PubMed  Google Scholar 

  46. Zendejas B, Brydges R, Hamstra SJ, Cook DA. State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg. 2013;257(4):586–93.

    Article  PubMed  Google Scholar 

  47. Palter VN, Grantcharov TP. Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial. Ann Surg. 2012;256(1):25–32.

    Article  PubMed  Google Scholar 

  48. Buscaglia J, Karas J, Palladino N, Fakhoury J, Denoya P, Nagula S, Bucobo JC, Bishawi M, Bergamaschi R. Simulated transanal NOTES sigmoidectomy training improves the responsiveness of surgical endoscopists. Gastrointest Endosc. 2014. pii: S0016-5107(13)02700-4. doi:10.1016/j.gie.2013.12.017. Epub ahead of print.

  49. Fox J, Gross CP, Longo W, Reddy V. Laparoscopic colectomy for the treatment of cancer has been widely adopted in the United States. Dis Colon Rectum. 2012;55(5):501–8.

    Article  PubMed  Google Scholar 

  50. Bardakcioglu O, Khan A, Aldridge C, Chen J. Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time. Ann Surg. 2013;258(2):270–4.

    Article  PubMed  Google Scholar 

  51. Lucciarini P, Konigsrainer A, Eberl T, Margreiter R. Tumour inoculation during laparoscopic cholecystectomy. Lancet. 1993;342(8862):59.

    Article  CAS  PubMed  Google Scholar 

  52. Simunovic M, Baxter NN, Sutradhar R, Liu N, Cadeddu M, Urbach D. Uptake and patient outcomes of laparoscopic colon and rectal cancer surgery in a publicly funded system and following financial incentives. Ann Surg Oncol. 2013;20(12):3740–6.

    Google Scholar 

  53. Thompson BS, Coory MD, Lumley JW. National trends in the uptake of laparoscopic resection for colorectal cancer, 2000–2008. Med J Aust. 2011;194(9):443–7.

    PubMed  Google Scholar 

  54. Cuschieri A. Nature of human error: implications for surgical practice. Ann Surg. 2006;244(5):642–8. Review.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Dinçler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P. Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum. 2003;46(10):1371–8; discussion 1378–9.

    Article  PubMed  Google Scholar 

  56. Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart Jr RW. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg. 1997;132(1):41–4; discussion 45.

    Article  CAS  PubMed  Google Scholar 

  57. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242(1):83–91.

    Article  PubMed Central  PubMed  Google Scholar 

  58. Cima RR, Hassan I, Poola VP, Larson DW, Dozois EJ, Larson DR, O’Byrne MM, Huebner M. Failure of institutionally derived predictive models of conversion in laparoscopic colorectal surgery to predict conversion outcomes in an independent data set of 998 laparoscopic colorectal procedures. Ann Surg. 2010;251(4):652–8.

    Article  PubMed  Google Scholar 

  59. Miskovic D, Ni M, Wyles SM, Tekkis P, Hanna GB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum. 2012;55(12):1300–10.

    Article  PubMed  Google Scholar 

  60. Simons AJ, Anthone GJ, Ortega AE, Franklin M, Fleshman J, Geis WP, Beart Jr RW. Laparoscopic-assisted colectomy learning curve. Dis Colon Rectum. 1995;38(6):600–3.

    Article  CAS  PubMed  Google Scholar 

  61. Mackenzie H, Miskovic D, Ni M, Parvaiz A, Acheson AG, Jenkins JT, Griffith J, Coleman MG, Hanna GB. Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees. Surg Endosc. 2013;27(8):2704–11.

    Article  PubMed  Google Scholar 

  62. Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB. Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg. 2010;252(6):943–51.

    Article  PubMed  Google Scholar 

  63. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg. 1997;84(2):273–8.

    Article  CAS  PubMed  Google Scholar 

  64. Miskovic D. Proficiency gain and competency assessment in laparoscopic colorectal surgery – thesis (PhD). Imperial College London; 2012.

    Google Scholar 

  65. Miskovic D, Ni M, Wyles SM, Kennedy RH, Francis NK, Parvaiz A, Cunningham C, Rockall TA, Gudgeon AM, Coleman MG, Hanna GB, National Training Programme in Laparoscopic Colorectal Surgery in England. Is competency assessment at the specialist level achievable? A study for the national training programme in laparoscopic colorectal surgery in England. Ann Surg. 2013;257(3):476–82.

    Article  PubMed  Google Scholar 

  66. Kuhry E, Bonjer HJ, Haglind E, Hop WC, Veldkamp R, Cuesta MA, Jeekel J, Påhlman L, Morino M, Lacy A, Delgado S, COLOR Study Group. Impact of hospital case volume on short-term outcome after laparoscopic operation for colonic cancer. Surg Endosc. 2005;19(5):687–92.

    Article  CAS  PubMed  Google Scholar 

  67. Ericsson KA. The acquisition of expert performance: an introduction to some of the issues. In: Ericsson KA, editor. The road to excellence: the acquisition of expert performance in the arts and sciences, sports and games. Mahwah: Erlbaum Lawrence Associates; 1996. p. 1–50.

    Google Scholar 

  68. Hyman N, Borrazzo E, Trevisani G, Osler T, Shackford S. Credentialing for laparoscopic bowel operation: there is no substitute for knowing the outcomes. J Am Coll Surg. 2007;205(4):576–80. Epub 2007 Aug 23.

    Article  PubMed  Google Scholar 

  69. Miskovic D, Ni M, Wyles SM, Parvaiz A, Hanna GB. Observational clinical human reliability analysis (OCHRA) for competency assessment in laparoscopic colorectal surgery at the specialist level. Surg Endosc. 2012;26(3):796–803.

    Article  PubMed  Google Scholar 

  70. Schlachta CM, Mamazza J, Grégoire R, Burpee SE, Pace KT, Poulin EC. Predicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage. Surg Endosc. 2003;17(8):1288–91.

    Article  CAS  PubMed  Google Scholar 

  71. Houck J, Kopietz CM, Shah BC, Goede MR, McBride CL, Oleynikov D. Impact of advanced laparoscopy courses on present surgical practice. JSLS. 2013;17(2):174–7.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Lewis T, Aggarwal R, Sugden C, Darzi A. The adoption of advanced surgical techniques: are surgical masterclasses enough? Am J Surg. 2012;204(1):110–4.

    Article  PubMed  Google Scholar 

  73. Sidhu RS, Vikis E, Cheifetz R, Phang T. Self-assessment during a 2-day laparoscopic colectomy course: can surgeons judge how well they are learning new skills? Am J Surg. 2006;191(5):677–81.

    Article  PubMed  Google Scholar 

  74. Chikkappa MG, Jagger S, Griffith JP, Ausobsky JR, Steward MA, Davies JB. In-house colorectal laparoscopic preceptorship: a model for changing a unit’s practice safely and efficiently. Int J Colorectal Dis. 2009;24(7):771–6.

    Article  PubMed  Google Scholar 

  75. Pigazzi A, Anderson C, Mojica-Manosa P, Smith D, Hernandez K, Paz IB, Ellenhorn JD. Impact of a full-time preceptor on the institutional outcome of laparoscopic colectomy. Surg Endosc. 2008;22(3):635–9.

    Article  PubMed  Google Scholar 

  76. Gagne RM. The conditions of learning. 4th ed. Orlando: Holt, Rinehart and Winston; 1985.

    Google Scholar 

  77. Jamali FR, Soweid AM, Dimassi H, Bailey C, Leroy J, Marescaux J. Evaluating the degree of difficulty of laparoscopic colorectal surgery. Arch Surg. 2008;143(8):762–7; discussion 768.

    Article  PubMed  Google Scholar 

  78. Wyles SM, Miskovic D, Ni Z, Acheson AG, Maxwell-Armstrong C, Longman R, Cecil T, Coleman MG, Horgan AF, Hanna GB. Analysis of laboratory-based laparoscopic colorectal surgery workshops within the English National Training Programme. Surg Endosc. 2011;25(5):1559–66.

    Article  PubMed  Google Scholar 

  79. Schlachta CM, Sorsdahl AK, Lefebvre KL, McCune ML, Jayaraman S. A model for longitudinal mentoring and telementoring of laparoscopic colon surgery. Surg Endosc. 2009;23(7):1634–8. Epub 2008 Dec 6.

    Article  PubMed  Google Scholar 

  80. Gumbs AA, Hogle NJ, Fowler DL. Evaluation of resident laparoscopic performance using global operative assessment of laparoscopic skills. J Am Coll Surg. 2007;204(2):308–13. Epub 2006 Dec 27.

    Article  PubMed  Google Scholar 

  81. Porte MC, Xeroulis G, Reznick RK, Dubrowski A. Verbal feedback from an expert is more effective than self-accessed feedback about motion efficiency in learning new surgical skills. Am J Surg. 2007;193(1):105–10.

    Article  PubMed  Google Scholar 

  82. Velchuru VR, Domajnko B, DeSouza A, Marecik S, Prasad LM, Park JJ, Abcarian H. Obesity increases the risk of postoperative peripheral neuropathy after minimally invasive colon and rectal surgery. Dis Colon Rectum. 2014;57(2):187–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, Advocate Lutheran General Hospital, University of Illinois MC, 1775 Dempster Ave., Park Ridge, IL, 60068, USA

    Slawomir Marecik MD, FACS, FASCRS

  2. Division of Colorectal Surgery, State University of New York, HSCT 18, Room 051, SUNY Stony Brook, Stony Brook, NY, 11794-8191, USA

    Roberto Bergamaschi MD, PhD, FRCS, FACS, FASCRS

Authors
  1. Slawomir Marecik MD, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Bergamaschi MD, PhD, FRCS, FACS, FASCRS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roberto Bergamaschi MD, PhD, FRCS, FACS, FASCRS .

Editor information

Editors and Affiliations

  1. NHS Foundation Trust, Yeovil District Hospital, Yeovil, United Kingdom

    Nader Francis

  2. Poissy Cedex, France

    Abe Fingerhut

  3. Stony Brook Medicine, New York, New York, USA

    Roberto Bergamaschi

  4. Colchester General Hospital, Colchester, Essex, United Kingdom

    Roger Motson

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag London

About this chapter

Cite this chapter

Marecik, S., Bergamaschi, R. (2015). Teaching Advanced Laparoscopic Skills in Colorectal Surgery. In: Francis, N., Fingerhut, A., Bergamaschi, R., Motson, R. (eds) Training in Minimal Access Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-6494-4_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6494-4_6

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6493-7

  • Online ISBN: 978-1-4471-6494-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation