Need for simulation in laparoscopic colorectal surgery training

Table 1 Distinctive features and challenges of laparoscopic surgery[20]

Features	Challenges
Two dimensional vision	Reduced perception of depth
A disturbed eye-hand-target axis	Decreases ergonomy and dexterity
Long and inflexible instruments	Natural hand tremor magnified
Rigid instruments with five degrees of freedom	Decreased dexterity and range of motion
Fixed abdominal entry points	Limited freedom of motion and movement of the instrument: The fulcrum effect
Camera instability	Increased fatigue
Limited tactile feedback	Decreases dexterity

Table 2 Characteristics of the different types of simulators

Type of simulator	Main features
Box trainers	Low-cost, portable, can be used repatedly by multiple users. Used to teach basic laparoscopic skills: hand-eye coordination, cutting, suturing, bimanual dexterity. Provide sensory feedback
	Requires direct observation and supervision by a trainer
Virtual reality simulators	Record several procedure metrics providing feedback to trainees. Recording of training performance for objective evidence of skill performance. Minor degree of sensory feedback and higher initial are the main disadvantages
Hybrid models	Reduced costs compared to cadaveric models. Questionable value of a training model with an alternative structure
Animal and human cadaveric models	Best anatomic and clinical-like model. Avaibility is limited and their use is expensive. Require operative facilities and a funeral service