Can the learning of laparoscopic skills be quantified by the measurements of skill parameters performed in a virtual reality simulator?

Natascha Silva Sandy,Homero Bruschini,Hiep Nguyen,Ricardo Jordao Duarte,Carlo Camargo Passerotti,Sabrina Thalita Dos Reis,Miguel Srougi,Eder Maxwell Gouveia,Jose Arnaldo Shiomi Da Cruz

doi:10.1590/s1677-5538.ibju.2013.03.10

Abstract

To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills.

Highlights

Among the most important advances made in surgery in the last three decades, one of the most significant is the clinical introduction of minimally invasive interventions through laparoscopy and, more recently, robotic-assisted laparoscopic surgery
Ten medical students with no previous experience in laparoscopy were recruited from the University of Sao Paulo Medical School, and ten urology residents (PGY3-5) with limited laparoscopic experience were recruited from the University of Sao Paulo Medical School
The many potential benefits of virtual reality surgical simulator (VRSS) have prompted their emergence as optimal tools for training outside operating room

Summary

Introduction

Among the most important advances made in surgery in the last three decades, one of the most significant is the clinical introduction of minimally invasive interventions through laparoscopy and, more recently, robotic-assisted laparoscopic surgery. Different clinical and laboratorial tools have been employed to combat this challenge, including the guidance of experienced mentors in patient interventions and training in animals or inanimate models [9,10] This “ex-vivo” learning is viewed as valuable because it eliminates the ethical constraint involved in teaching surgery in animal models or humans, is considered efficient in the acquisition of psychomotor skills, is secure, and has a reasonable cost [11]. For these reasons, with the goal of improved patient safety and surgical efficiency, much emphasis has been placed on training laparoscopic skills using simulators that replicate the conditions encountered during actual surgeries

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