Laparoscopic training should be equitable for all: the impact of a mandatory, cost-neutral simulation training programme incorporating a free take-home box trainer.

Background: The quality of gynaecological surgical training has faced mounting criticism internationally with multiple countries publishing potential remedies for improvement. Simulation has the indisputable ability to mitigate against training deficiencies, however, access to and the quality of simulation varies across regions, never mind nations.

Objectives: To assess the effect on surgical skills by the introduction of a structured and integrated simulation programme with the unique aspect of being completely free of cost with the provision of a take-home laparoscopy box trainer (LBT).

Materials and methods: The course was mandatory in attendance and was divided into basic, intermediate and advanced streams. Each stream had a bespoke curriculum based on RCOG training. It was delivered through a combination of lectures and a mixture of dry/wet lab training sessions with the LBT provided for home use.

Main outcome measures: All participants completed a pre- and post-course questionnaire with objective laparoscopic skill metrics assessed using the Inovus LapAR system at the beginning and end of the course.

Results: 100% of trainees demonstrated a statistically significant (p=<0.05) improvement in smoothness, time and speed. Furthermore, 100% reported the course improved their surgical skills which were further developed by LBT practice.

Conclusion: This demonstrated improvement in surgical skills and confidence solidifies the hope that such a programme could be implemented as an international gynaecological standard. If implemented from the initial specialist years of training, a strong foundation can be instilled to ensure that each future gynaecologist has strong surgical skills built from a high level of laparoscopic simulation.

What is new?: Our study is the first of its kind to describe an equitable and fair approach to laparoscopic surgery training; for the many rather than the select few.