Minimal Access Surgery (MAS) has multi-faceted implications on the different stakeholders involved in implementation. It requires the surgeon to cope with the ergonomic and cognitive challenges required to perform a surgical procedure. It needs the surgical team to work coherently for the smooth functioning of the technologically complex operating room (OR). It needs educators and policy makers to embrace reform into the novel practices of training skills in MAS. It needs the industry to engage in research to bring out newer tools and technologies akin to training tools. This thesis explores the premise of implementation of MAS in the areas of curriculum design, implementation of training protocols, assessment tools and emerging technologies and trends that improve the learning curve and the transfer of skills from a skills lab setting to the OR. Several surgeons were included from different parts of Europe and India with expertise levels ranging from novice to expert.

To study the unique requirements of individual surgeons and the detriments of performance the Laparoscopic Surgical Skills (LSS) Grade 1 Level 1 was used as a common training curriculum. First, a worldwide survey was conducted on the variety of training modalities and tools. Then, Self-assessment and the implications of “reflection-before-practice” on skills progression was studied. Automated assessment tools were devised using motion tracking software and thresholds for optimal performance were proposed. Physiological markers were studied during OR performance to determine factors that influence immersion in virtual reality surroundings and replicated in physical space using 3D projection for team training. Evolving technology in MAS requires multifaceted approach from training to customization to ensure optimal and efficient patient and ergonomic outcomes.
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