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Section I Laparoscopic Skills1 Surgeons' Skills Training
Boel A. Fransson, Chiya Chen and Claude A. Ragle
Adding Minimally Invasive Surgery to a Surgeon's Repertoire
Within the last decade, veterinary medicine has started to increasingly recognize the importance of skills development for surgeons who want to incorporate minimally invasive surgery (MIS) in their clinical practice.
Even for surgeons with considerable expertise in traditional open surgery, it often becomes readily apparent that some laparoscopic skills are distinctly different from those of open surgery. The challenges and differences include the use of long instruments, which magnifies any tremor and limits tactile sensation, often referred to as haptic feedback. When the instrument movement is limited by a portal into the body cavity, the surgeon needs to handle the resulting fulcrum effect and the loss of freedom to simply alter an approaching angle. But even more important, the normal binocular vision becomes monocular; as a result, the associated depth perception is lost. Other challenges include the loss of a readily accessible bird's eye view of the entire body cavity. The advantage of magnification may be perceived as offset by a reduced field of view, and any instrument activity outside the view becomes a liability.