The Evaluation of Learning Curves in Novice Laparoscopists: Incorporating Direct Visualization into the Simulation Training Program

Abstract

Technological developments have led to resurgent interest in stereoscopic visualization for laparoscopy. Evidence suggests that trainees achieve proficiency on the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) in less total training time when using stereo visualization. Data from trainees using the Fundamentals of Laparoscopic Surgery (FLS) curriculum to train the MISTELS tasks indicate that the peg transfer task requires the greatest training time to reach proficiency. This task challenges basic hand‐eye coordination that is critical to performing more complex tasks. As monoscopic visualization remains the standard of care, our goal remains to train proficiency under monoscopic visualization. However, we propose incorporating stereo‐direct visualization (SDV) using open FLS box trainers, into the curriculum to accelerate learning. Novice surgery residents will train with the peg transfer task. Half will train to proficiency (< 54 sec) under standard monoscopic video visualization. The SDV group will train to proficiency, then switch to traditional monoscopic video visualization and continue to train until proficiency is reached. We hypothesize that SDV training will facilitate the perceptual switch to reach proficiency in less total time. Results from this study may be employed to further guide the development of laparoscopic training curricula.