Methods of substitution in laparoscopic surgical training.

The laparoscopic surgery laboratory was created by P. Morel, MD, Head of the Department of Surgery, Hospital of Geneva, in 1993. Originally, we used pigs for all kinds of training, as many other laboratories do. After one year of practice, it appeared to me that the use of pigs was not as efficient as we thought it would be besides raising many ethical questions. The problem at that time, was how to find and how to organise our laboratory to use alternative methods. We had some contact with a group in Bregenz who developed a trainer using organs from the slaughter-house. In 1995, the LSCV (Ligue Suisse Cantre la Vivisection, Cll-Thonex) offered our laboratory a first trainer especially designed for isolated organs. The problem of organ procurement arose quickly. First we approached big slaughter-houses, but this was problematic since we were slowing their processing by requiring special preparations. Eventually, we found some small slaughter-houses in which the butchers agreed to cut the viscera according to our needs. From then on, the use of trainers became our golden standard in basic training. We made another step forward by using non-animal material for elementary training: latex sponges for suturing and tying knots, matches, rice, chick-peas, elastics and other materials to train the accuracy of manipulations. The laboratory was progressively equipped with deep-freezers in order to have preparations from the slaughterhouses available at any time. This was very satisfactory, however we were absolutely conscious that a cholecystectomy realised using a classical trainer was quite far away from the real clinical situation. In 1996, pigs were only used for specialised surgery: gastric surgery, hernia repair, colectomy and nephrectomy. During the year 1997, thanks to the efforts of G. de Candolle, MD, Gynae-