The role of the assistant in laparoscopic surgery: important considerations for the apprentice-in-training.

Laparoscopic surgery is a dynamic and integral component of surgical training. In many surgical programs, the surgeon-in-training gradually incorporates the knowledge and skill-sets through a variable spectrum of assistant/ apprentice instruction with different surgical mentors. As a result, this lack of formal and/or standardized instruction may be inconsistent with a structured educational process. In the year 2008, with widespread applications for minimally invasive techniques and technology, contributions from skilled assistants are now increasingly more important for effective and safe operative conduct. Incorporating these challenges into a balanced educational process remains no easy matter. The authors believe the assistant's role is vital to all aspects of laparoscopic surgery, no matter how routine or complex. Laparoscopic assistants should participate and contribute directly in the (a) preoperative evaluation and preparation, (b) patient positioning, (c) operative suite arrangement, (d) trocar placement, plus important (e) intraoperative maneuvers contingent upon acquired mastery of laparoscopic skills. Understanding these principles plus effective administration of various duties allows for the apprentice in training to progress to more complex procedures and eventual primary surgeon responsibility. In this report, the role of the laparoscopic assistant/apprentice is reviewed, with particular attention focused on requisite fundamentals for evolving laparoscopic surgeons. To date, there are few publications within the world literature that directly address these observations. Important considerations delineating the expectations and goals for the assistant/apprentice, as well as the mentor, during laparoscopic training are provided.