In Japan, there are not so much obesity patients, so today I will present our style of laparoscopic surgical training.

We think to become more skilled surgeon, we needs 3 training. Training head, eyes, and hands.

To train head means to build our store of knowledge of anatomy, devices of laparoscopy, simple and advanced power source. To train eyes means to learn techniques of laparoscopy, such as dissection, cutting, ligation, hemostasis, and trouble shooting. But more important is to train hands. It means perform operation by using forceps and it takes a long time to use forceps at will.

In our institution, every GYN doctor has drybox, and trains suturing every day. We value dry box suturing, because suturing technique includes bi-hand coordination, precise maneuver of forceps, and ligation. Laparoscopic suturing techniques are one way to expand the boundaries of minimally invasive gynecologic surgery. It has been our goal to improve suturing skills through training using a dry box and in an animal laboratory in order to master basic suturing and apply those skills to laparoscopic clinical cases. Before mastering intracorporeal suturing, we could only perform simple procedures laparoscopically. With the introduction fundamental lapaproscopic suturing techniques, it became possible to perform an ever expanding number of techniques for various diseases.

After dry box training, we start total laparoscopic hysterectomy(TLH), and myomectomy with senior doctor step by step. And our goal is perform TLH as an operator in 18 months.