**6. Training**

Training in laparoscopic surgery is important for surgeons. Also, studies about effective training method are important for better learning curve. There are many surgical simulators using computer graphics, rubber phantom, and harvested animal organ. However, measuring surgical skill quantitatively was very difficult. Quantification of skill is important not only for qualifying each surgeon but also for evaluating the effectiveness of training method. We have developed a suture simulator and evaluation software (**Figure 15**) [56, 57]. The phantom mimicking small intestine, made of four layers and string braided rubber, is used for the task. The task is anastomosis of the defect on the intestine by three interrupted sutures. The result is evaluated by five category including completion time, air leakage test, etc. The trainees can be fed back each time by score. Scoring system was developed using data previously obtained from skilled surgeons performing suture on this phantom. By using this simulator, significant difference between the trainees' scores before and after training was observed [57].

**Figure 15.** *Training simulator.*
