With the introduction of minimally invasive surgery (MIS), the patient experiences the benefits of less pain, a more rapid recovery and a shorter stay in hospital. However, MIS provides many challenges to surgeons and they need extensive training to acquire this new technique. This training consists of developing cognitive, clinical, and technical skills. However, acquiring full training ‘‘on the job’’ is not always possible because of patient safety and restrictions of residents’ working hours. This situation led to the development of surgical skills centres or laboratories. These skills laboratories can offer a protected, mistake-free training environment and validated surgical training curriculum that allows surgical trainees to practice in a safe and controlled preclinical environment before operating on actual patients. In addition, following the example of the aviation and military industries, surgical simulation is now being widely used to train surgical trainees from basic tasks to cognitively demanding tasks. The overall aim of this thesis is to define the optimal ergonomic settings and conditions needed to provide an optimal environment for effective training in MIS. This environment should allow training resembling actual laparoscopic surgery in a real OR. In order to achieve this, the study included an elaborate literature review, experimental investigation and design cases. This thesis is divided into three parts referred to as Parts A, B and C. Part A (Chapters 2 and 3) focuses on the review of ergonomic factors during laparoscopic surgery and training; Part B (Chapters 4, 5 and 6) describe a portable Ergo-Lap simulator and the validation of this simulator with laparoscopic specialist and surgical trainees. And finally, Part C (Chapter 7) focuses on distractions and interferences during the intro-operative procedure. Part A deals with ergonomic factors during laparoscopic surgery and training. Chapter 2 investigates ergonomic factors that can influence the task performance, and evaluates the effect of these ergonomic factors on task performance and trainees’ posture during laparoscopic surgery training. Posture analysis showed that subjects can keep a much more neutral posture under optimal conditions than under non-optimal conditions. The subjects experienced less joint excursion and less discomfort in their necks, shoulders, and arms under optimal conditions. Significant differences of task performance showed that the group trained under the optimal ergonomic setting performed significantly better than that the group trained under a non-optimal setting. It can be concluded that surgeons’ learning skills are affected by the ergonomics of simulation setting. Chapter 3 investigates ergonomic factors that can influence surgical training efficiency in several aspects by adopting the ergonomic guidelines for the OR and MIS procedures, performing observations in the OR and in the skills lab as well as interviewing expert surgeons on their opinion of the optimal ergonomic setting in general of skills lab. This chapter also discusses a case study of designing a surgical training table. The aim of this case study is to design an optimal table to meet multiple training requirements, particularly for laparoscopy surgical training. Part B focuses on design and validation of a portable ergonomic laparoscopic simulator (Ergo-Lap simulator). Chapter 4 describes the scientifically-based development of an inexpensive and portable multi-task Ergonomic Laparoscopic Skills (Ergo-Lap) simulator. The design of this Ergo-Lap simulator and related training task panel was based on scientific research regarding the representative skills and the ergonomic guidelines for laparoscopic surgery. A user-centred design approach was followed. Chapter 5 is intended to verify the face and content validity of the new portable Ergonomic Laparoscopic Skills simulator (Ergo-Lap simulator) and to assess the construct validity of the Ergo-Lap simulator in four basic skills tasks. This Ergo-Lap simulator with multiple tasks was rated as a useful training tool that can distinguish between various levels of laparoscopic expertise. Chapter 6 evaluates the face validity of the Ergo-Lap simulator for training basic single-incision laparoscopic surgical skills (SILS). The Ergo-Lap simulator was taken to the 20th International Congress of the EAES 2012 in Brussels. During the congress, the simulator was assessed by 13 general surgeons with different levels of SILS experience using a standardized questionnaire to determine the usability of the Ergo-Lap simulator training for basic SILS skills. For SILS skills training, this inexpensive and portable Ergo-Lap simulator offers a feasible training opportunity to help trainees to practice their SILS skills. Part C focuses on distractions during the intra-operative procedure. Chapter 7 contains a systematic literature search conducted to review the literature on distractions and interruptions during intra-operative phase of different surgical procedures in both the real OR and skills lab setting. In total, 27 articles were included in this review. Twelve observational studies were carried out during the OR to observe interruptions and distractions during the procedure. In addition, 11 experimental studies used a surgical simulator with simulated distractions and interruptions to investigate the effect of distracting events on the task performance. In four qualitative studies the surgical team was interviewed to investigate the influence of intra-operative distractions on their performance. Surgeons face multiple distractions and interactions during surgery, most of which can cause stress to the surgeon and may disrupt the surgical flow, potentially resulting in adverse events. Thorough analysis of interruptions and the way surgeons cope with them could potentially contribute to the positive outcome of procedures. Analysis of experimental studies focusing on the effects of disruptions and interrupting events both in the OR and skills lab setting provide evidence for the need to develop an effective, comprehensive training programme in an environment similar to the OR. Finally, Chapter 8 recapitulates all the research findings and discusses these in a wider range. Factors which are relevant for surgical training efficiency are discussed. The recommendations for the setting up of the skills lab and future research are described.