The LESS approach entails greater level of muscular activity in the trapezius and forearm extensor muscles, but we have found evidences of a better wrist position during LESS compared with traditional laparoscopy.

Training obtained during the first module of our training model significantly decreased performance times for ex vivo urethrovesical anastomosis, simultaneously increasing its quality. In addition, validation of the training model was also demonstrated by the highly scored evaluation resulting from the attendants' assessment.

Data glove CyberGlove® allows for the distinction between two laparoscopic exercises performed with different instruments. Also, laparoscopic intracorporeal suturing when performed with an axial-handled needle holder entails a more ergonomic posture for the wrist joint. Previous minimally invasive surgical experience is a positive influencing factor on the surgeons' wrist postures during laparoscopy.

We conclude that the least adequate instrument set for initiation in LESS surgery is the one that combines two dynamic articulating tip instruments, as this has consistently obtained the worst results in all trials. Further data on more complex tasks and on a complete learning and skills-acquisition program must be obtained to confirm these findings.

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