All recent data show that the technique is feasible, safe, but will require new randomized studies in order to clarify its indications and a cost effectiveness study of this novel technique will seriously be required [20]. 5. Conclusion Single-incision laparoscopic surgery is a feasible way to perform appendectomy. This includes Ganetespib order obese patients, uncomplicated and complicated appendicitis as well as exploratory laparoscopy. Conversion to a three-port operation should be done in any case when optimal or suboptimal conditions are not present. As patients’ safety was the most important patients with acute appendicitis should be the ones in order to begin the SPAA technique. The expense and added operative time should be evaluated if it provides the patients with minimal, if any, apparent scarring.

Patients are more satisfied with SPAA than LA approach regarding the cosmetic result. Refinements in instrumentation will enable wider use of this novel minimally invasive approach. The true benefit of the technique should be assessed by new randomised controlled trials.
Laparoscopic surgery is technically demanding and requires psychomotor skills different from those needed in open surgery. Training in laparoscopic surgery is done in the operating theatre but in the future we have to expect increasing focus on ethics and patient safety. This might demand better and more intensive training in a safer environment prior to training in the operating theatre. Recently, the acquisition of such skills has been via didactic lectures and simulator training [1], which is provided in the Core Laparoscopic Skills Course (CLSC).

A wide variety of laparoscopic simulators are now available, and they can be broadly classified into videoscopic and computer-driven laparoscopic simulation platforms, which are further divided into virtual reality (VR) and computer-enhanced videoscopic trainers. These trainers primarily differ in their user interface and ability to provide reliable performance measurements. Videoscopic trainer allows manipulation of actual physical objects and requires manual data collection. In contrast, VR trainer utilises a virtual environment and provides computer automated performance metrics and is considered an educational tool with great potential [2�C7]. In recent years more realistic VR simulators have been developed for basic and advanced laparoscopic skills training.

The aim of this study was to determine the role of the CLSC in developing laparoscopic skills using the VR. 2. Design Between 2008 and 2010, doctors with minimal laparoscopic surgery experience attending the CLSC participated in this study. Initial teaching session (10�C15 minutes) was given to explain how to perform PEG transfer (Figure 1) Carfilzomib and clipping skills (Figure 2) using the VR. Figure 1 PEG transfer using the VR. Figure 2 Clipping skills using the VR. The VR simulator used was Immersion Virtual Laparoscopic Interface (Immersion Medical, Gaithersburg, MD).