Laparoscopic Psychomotor Skills Research Articles

Origami Box Folding Exercise: A laparoscopic box simulation training and assessment method in facilitating laparoscopic psychomotor skills with minimal preparation

ObjectiveLaparoscopic box simulation training is widely recognized as an assessment tool to facilitate psychomotor skills especially for novice surgeons. However, current commercialized training modules including pegs, gauze, clips, pins etc. are generally costly and relatively inaccessible. We introduce a simple and pioneer surgical training drill, the Origami Box Folding Exercise (OBFE), based on the validated evaluating system of objective structured assessment of technical skills (OSATS) constructed with the scoring system of procedure-specific checklist (PSC) and global rating scale (GRS). Materials and methodsFace and content validation of the OBFE and OSATS are evaluated by five endoscopic experts from two medical centers in Taiwan. This is a prospective observational study analyzing the pre-test/post-test result of OBFE from 37 participants in two individual workshops as training and evaluating method for laparoscopic psychomotor skills. Both the pre and post tests are video recorded with a time limit of 5 min graded by two independent evaluators based on the OSATS scoring system. ResultsThe reliability of PSC, GRS, and intergroup value between PSC and GRS were 0.923, 0.926 and 0.933, respectively. Inter-rater reliability of PSC, GRS, and both were 0.985, 0.932 and 0.977, respectively. Construct validity of PSC and GRS were statistically significant, with p-value 0.006 and 0.001, respectively. ConclusionOBFE enhances laparoscopic psychomotor skills with requirement of a single piece of paper. The associated OSATS tool for a 5-min OBFE test was validated. OBFE training is an efficient training and assessment system to promote psychomotor skills in laparoscopic box simulation drill which requires simple and economical preparation.

Face, content, and construct validity of the virtual immersive operating room simulator for training laparoscopic procedures.

The aim of this work is to present the face, content, and construct validation of the virtual immersive operating room simulator (VIORS) for procedural training of surgeons' laparoscopic psychomotor skills and evaluate the immersive training experience. The VIORS simulator consists of an HMD Oculus Rift 2016 with a visor on a 1080 × 1200 pixel OLED screen, two positioning sensors with two adapted controls to simulate laparoscopic instruments, and an acrylic base to simulate the conventional laparoscopic setup. The immersion consists of a 360° virtual operating room environment, based on the EndoSuite at Hospital Infantil de Mexico Federico Gomez, which reproduces a configuration of equipment, instruments, and common distractions in the operating room during a laparoscopic cholecystectomy procedure. Forty-five surgeons, residents, and medicine students participated in this study: 27 novices, 13 intermediates, and 5 experts. They completed a questionnaire on the realism and operating room immersion, as well as their capabilities for laparoscopic procedural training, scored in the 5-point Likert scale. The data of instrument movement were recorded and analyzed using 13 movement analysis parameters (MAPs). The experience during training with VIORS was evaluated through NASA-TLX. The participants were enthusiastic about the immersion and sensation levels of the VIORS simulator, with positive scores on the realism and its capabilities for procedural training using VIORS. The results proved that the VIORS simulator was able to differentiate between surgeons with different skill levels. Statistically significant differences were found in nine MAPs, demonstrating their construct validity for the objective assessment of the procedural laparoscopic performance. At cognitive level, the inversion experience proves a moderate mental workload when the laparoscopic procedure is carried out. The VIORS simulator has been successfully presented and validated. The VIORS simulator is a useful and effective device for the training of procedural laparoscopic psychomotor skills.

A randomized control trial to evaluate the importance of pre-training basic laparoscopic psychomotor skills upon the learning curve of laparoscopic intra-corporeal knot tying

BackgroundTraining of basic laparoscopic psychomotor skills improves the acquisition of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial was designed to evaluate whether pre-training of basic skills, as laparoscopic camera navigation (LCN), hand-eye coordination (HEC), and bimanual coordination (BMC), and the combination of the three of them, has any beneficial effect upon the learning curve of LICK. The study was carried out in a private center in Asunción, Paraguay, by 80 medical students without any experience in surgery. Four laparoscopic tasks were performed in the ENCILAP model (LCN, HEC, BMC, and LICK). Participants were allocated to 5 groups (G1–G5). The study was structured in 5 phases. In phase 1, they underwent a base-line test (T1) for all tasks (1 repetition of each task in consecutive order). In phase 2, participants underwent different training programs (30 consecutive repetitions) for basic tasks according to the group they belong to (G1: none; G2: LCN; G3: HEC; G4: BMC; and G5: LCN, HEC, and BMC). In phase 3, they were tested again (T2) in the same manner than at T1. In phase 4, they underwent a standardized training program for LICK (30 consecutive repetitions). In phase 5, they were tested again (T3) in the same manner than at T1 and T2. At each repetition, scoring was based on the time taken for task completion system.ResultsThe scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). The LICK group learning curves fitted better to the two-phase exponential decay model. From these curves, the starting points (Y0), the point after HEC training/before LICK training (Y1), the Plateau, and the rate constants (K) were calculated. All groups, except for G4, started from a similar point (Y0). At Y1, G5 scored already better than the others (G1 p = .004; G2 p = .04; G3 p < .0001; G4 NS). Although all groups reached a similar Plateau, G5 has a quicker learning than the others, demonstrated by a higher K (G1 p < 0.0001; G2 p < 0.0001; G3 p < 0.0001; and G4 p < 0.0001).ConclusionsOur data confirms that training improves laparoscopic skills and demonstrates that pre-training of all basic skills (i.e., LCN, HEC, and BMC) shortens the LICK learning curve.

Dominant hand, non-dominant hand, or both? The effect of pre-training in hand-eye coordination upon the learning curve of laparoscopic intra-corporeal knot tying

BackgroundTraining of basic laparoscopic psychomotor skills improves both acquisition and retention of more advanced laparoscopic tasks, such as laparoscopic intra-corporeal knot tying (LICK). This randomized controlled trial (RCT) was performed to evaluate the effect of different pre-training programs in hand-eye coordination (HEC) upon the learning curve of LICK.ResultsThe study was performed in a private center in Asunción, Paraguay, by 60 residents/specialists in gynaecology with no experience in laparoscopic surgery. Participants were allocated in three groups. In phase 1, a baseline test was performed (T1, three repetitions). In phase 2, participants underwent different training programs for HEC (60 repetitions): G1 with both the dominant hand (DH) and the non-dominant hand (NDH), G2 with the DH only, G3 none. In phase 3, a post HEC/pre LICK training test was performed (T2, three repetitions). In phase 4, participants underwent a standardized training program for LICK (60 repetitions). In phase 5, a final test was performed (T3, three repetitions). The score was based on the time taken for task completion system. The scores were plotted and non-linear regression models were used to fit the learning curves to one- and two-phase exponential decay models for each participant (individual curves) and for each group (group curves). For both HEC and LICK, the group learning curves fitted better to the two-phase exponential decay model. For HEC with the DH, G1 and G2 started from a similar point, but G1 reached a lower plateau at a higher speed. In G1, the DH curve started from a lower point than the NDH curve, but both curves reached a similar plateau at comparable speeds. For LICK, all groups started from a similar point, but immediately after HEC training and before LICK training, G1 scored better than the others. All groups reached a similar plateau but with a different decay, G1 reaching this plateau faster than the others groups.ConclusionsThis study demonstrates that pre-training in HEC with both the DH and the NDH shortens the LICK learning curve.

Validation Study of a Portable Home Trainer Using a Pad for Laparoscopic Practice.

The aim of this study was to describe and validate a homemade laparoscopic trainer. The abdominal cavity is simulated within a 3-mm-thick stainless steel model. Thirty-four participants were evaluated in a pilot study to validate our model. Participants were divided into experts (n = 19) and novices (n = 15) to perform basic and complex laparoscopic skills. The comparison between the homemade trainer (HT) and the standard laparoscopic trainer showed no significant differences for the 2 tasks performed for each group ( P > .05). The experts' performance of the 2 tasks was statistically different from the novices ( P < .05) on both trainers. Both experts (84%) and novices (87%) approved the HT as an effective home trainer. Our HT seems to fulfill the conditions of performing the basic and complex laparoscopic psychomotor skills at a low cost and similar efficiency.

Investigating laparoscopic psychomotor skills in veterinarians and veterinary technicians

To determine the influence of age, year of graduation, and video game experience on baseline laparoscopic psychomotor skills. Cross-sectional. Licensed veterinarians (n = 38) and registered veterinary technicians (VTs) (n = 49). A laparoscopic box trainer was set up at the 2016 Ontario Veterinary Medical Association (OVMA) and the 2016 Ontario Association of Veterinary Technicians (OAVT) conferences held in Toronto, Ontario, Canada. Participants volunteered to perform a single repetition of a peg transfer (PT) exercise. Participants were given a short demonstration of the PT task prior to testing. A Spearman's rank correlation (rs ) was used to identify associations between baseline psychomotor skills and self-reported surgical and non-surgical experiences collected via survey. Mann-Whitney U tests were used to compare PT scores in veterinarians and VTs. A P-value of < .05 was considered significant. The mean age of participants was 36 years (range 21-67) and the majority were female (83%). In veterinarians, PT scores were highest in the most recent graduates (P = .01, rs = 0.42), and PT scores increased with self-reported VG experience (P = .02, rs = 0.38). PT scores correlated inversely with age (P = .02, rs = -0.37). No associations were observed in VTs (P > .05). Veterinary technicians that frequently used chopsticks scored higher than those without chopstick experience (P = .04). Age and year of graduation correlated inversely, while self-reported VG experience correlated positively with laparoscopic psychomotor skills of veterinarians, when assessed on a simulator. The use of chopsticks may contribute to the acquisition of psychomotor skills in VTs.

Retention of laparoscopic psychomotor skills after a structured training program depends on the quality of the training and on the complexity of the task.

This follow-up RCT was conducted to evaluate laparoscopic psychomotor skills retention after finishing a structured training program. In a first study, 80 gynecologists were randomly allocated to four groups to follow different training programs for hand-eye coordination (task 1) with the dominant hand (task 1-a) and the non-dominant hand (task 1-b) and laparoscopic intra-corporeal knot tying (task 2) in the Laparoscopic Skills Testing and Training (LASTT) model. First, baseline skills were tested (T1). Then, participants trained task 1 (G1: 1-a and 1-b, G2: 1-a only, G3 and G4: none) and then task 2 (all groups but G4). After training all groups were tested again to evaluate skills acquisition (T2). For this study, 2 years after a resting period, 73 participants were recruited and tested again to evaluate skills retention (T3). All groups had comparable skills at T1 for all tasks. At T2, G1, G2, and G3 improved their skills, but the level of improvement was different (G1 = G2 > G3 > G4 for task 1; G1 = G2 = G3 > G4 for task 2). At T3, all groups retained their task 1 skills at the same level than at T2. For task 2, however, a skill decay was already noticed for G2 and G3, being G1 the only group that retained their skills at the post-training level. Training improves laparoscopic skills, which can be retained over time depending on the comprehensiveness of the training program and on the complexity of the task. For high complexity tasks, full training is advisable for both skills acquisition and retention.

Construct validity of a video-tracking system based on orthogonal cameras approach for objective assessment of laparoscopic skills

This study was aimed to establish the construct validity of a video-tracking system based on orthogonal cameras approach for assessment of laparoscopic psychomotor skills in training environments. The camera-tracking system consists of two webcams placed in orthogonal configuration at a distance of 13.5 cm. The orthogonal cameras employ a color segmentation algorithm to register the 3D motions of the laparoscopic instruments using colored tapes placed on the distal end. For construct validity, 31 participants (4 experts and 27 residents) performed three training tasks in a laparoscopic box trainer with the built-in orthogonal cameras system. Eleven motion-related parameters were used to evaluate their performance. Statistical analysis was performed, and results between two groups were compared using a Mann-Whitney U-test. Construct validity results showed statistical differences in almost all motion-related parameters for assessment of laparoscopic technical skills. Results demonstrated that the orthogonal video-based tracking system was able to differentiate laparoscopic experience between experts and trainees surgeons. The orthogonal cameras system was successfully validated in a laparoscopic box trainer. This video-based tracking system was able to distinguish performance between experts and trainees surgeons, showing its potential as a reliable tool to assess laparoscopic psychomotor skills. The orthogonal cameras allow incorporating the advantages of this video motion-tracking technology with the benefits of the traditional laparoscopic box trainers, creating realistic haptic feedback and allowing the evaluation of psychomotor skills of the surgeons.

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons.

The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons' psychomotor skills. Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand-eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach's α test. Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons.

EVA: Laparoscopic Instrument Tracking Based on Endoscopic Video Analysis for Psychomotor Skills Assessment

The EVA (Endoscopic Video Analysis) tracking system is a new system for extracting motions of laparoscopic instruments based on nonobtrusive video tracking. The feasibility of using EVA in laparoscopic settings has been tested in a box trainer setup. EVA makes use of an algorithm that employs information of the laparoscopic instrument's shaft edges in the image, the instrument's insertion point, and the camera's optical center to track the three-dimensional position of the instrument tip. A validation study of EVA comprised a comparison of the measurements achieved with EVA and the TrEndo tracking system. To this end, 42 participants (16 novices, 22 residents, and 4 experts) were asked to perform a peg transfer task in a box trainer. Ten motion-based metrics were used to assess their performance. Construct validation of the EVA has been obtained for seven motion-based metrics. Concurrent validation revealed that there is a strong correlation between the results obtained by EVA and the TrEndo for metrics, such as path length (ρ = 0.97), average speed (ρ = 0.94), or economy of volume (ρ = 0.85), proving the viability of EVA. EVA has been successfully validated in a box trainer setup, showing the potential of endoscopic video analysis to assess laparoscopic psychomotor skills. The results encourage further implementation of video tracking in training setups and image-guided surgery.

Systematic review of serious games for medical education and surgical skills training

The application of digital games for training medical professionals is on the rise. So-called 'serious' games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games. PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria. A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use. Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula.

Validation of a new box trainer-related tracking device: the TrEndo

BackgroundThere is an increasing demand for structured objective ex vivo training and assessment of laparoscopic psychomotor skills prior to implementation of these skills in practice. The aim of this study was to establish the internal validity of the TrEndo, a motion-tracking device, for implementation on a laparoscopic box trainer.MethodsFace validity and content validity were addressed through a structured questionnaire. To assess construct validity, participants were divided into an expert group and a novice group and performed two basic laparoscopic tasks. The TrEndo recorded five motion analysis parameters (MAPs) and time.ResultsParticipants demonstrated a high regard for face and content validity. All recorded MAPs differed significantly between experts and novices after performing a square knot. Overall, the TrEndo correctly assigned group membership in 84.7 and 95.7% of cases based on two laparoscopic tasks.ConclusionFace, content, and construct validities of the TrEndo were established. The TrEndo holds real potential as a (home) training device.

Effect of caffeine and taurine on simulated laparoscopy performed following sleep deprivation

Sleep deprivation affects surgical performance and has the potential to endanger patient safety. Pharmacological stimulants may counter this consequence of long working hours. This study aimed to investigate whether commonly available stimulants can counter the effects of fatigue on technical and neurocognitive skill. This was a single-blind crossover study of surgical novices trained to proficiency on the Minimally Invasive Surgical Trainer-Virtual Reality laparoscopic simulator. Participants were acutely sleep-deprived three times each, followed by administration of either placebo, 150 mg caffeine, or 150 mg caffeine combined with 2 g taurine before simulated laparoscopy. Outcome measures were: laparoscopic psychomotor skill, cognitive performance and the Stanford Sleepiness Scale (range 1-7). Rested baselines were gathered following completion of test sessions. Baseline performance was recorded for 18 participants in the rested state. Sleep-deprived participants receiving the placebo took longer (median 41 versus 35 s; P = 0·016), were less economical with movement (3·25 versus 2·95 m; P = 0·016) and made more errors (66 versus 59; P = 0·021) on the laparoscopic task compared with the rested state. Caffeine restored psychomotor skills to baseline for time taken (37 versus 35 s; P = 0·101), although the number of errors remained significantly greater than in the rested state (63 versus 59; P = 0·046). Sleep-deprived subjects receiving placebo had slower reaction times (377 versus 299 ms; P = 0·008) and a higher score on the Stanford Sleepiness Scale (6 versus 2 points; P = 0·001) than rested surgeons. Negative effects of sleep deprivation on reaction time were reversed when caffeine (307 ms versus 299 ms in rested state; P = 0·214) or caffeine plus taurine (326 versus 299 ms; P = 0·110) was administered. Subjective sleepiness was also improved, but not to baseline levels. Sleep deprivation affects laparoscopic psychomotor skills, reaction time and subjective measures of sleepiness in novice surgical subjects. Caffeine and taurine restore simulated laparoscopic performance to rested levels, but do not reduce errors.

A Valid Model for Testing and Training Laparoscopic Psychomotor Skills

A number of training devices and methods for laparoscopic skills acquisition have been developed. Very few have focused on the specific essential laparoscopic psychomotor skills (LPS) required for a future laparoscopist to be able to enter in a one-to-one teaching process in the operating room. The Laparoscopic Skills Testing and Training (LASTT) model is a new in vitro model developed by the European Academy of Gynaecological Surgery to measure LPS. It has been well demonstrated that this model can distinguish between experienced and inexperienced surgeons, and some investigators have suggested that it may be cost effective for continuous training and evaluation of LPS in all surgical disciplines performing laparoscopic procedures. The study investigated the face and construct validity of the LASTT model for measuring LPS. The study subjects were residents and gynecologists with different levels of experience in laparoscopic surgery (n = 199), who attended workshops organized by the European Academy of Gynaecological Surgery in 2008 and 2009. To correlate between the level of clinical experience and proficiency in the essential LPS, the participants were classified in 3 groups (G1: no/little, G2: intermediate, G3: important). The ability of the study subjects to perform 3 standardized exercises (E1: camera navigation, E 2 : hands-eyes coordination, and E 3 : bimanual coordination) was investigated for specific measurable objectives within a defined time frame. An 11-item questionnaire using a 10-cm visual analogue scale evaluated the face validity of the LASTT model. Its capacity for testing and training LPS was assessed in Question 1 to Question 8, and its relevance for actual laparoscopic surgery was addressed in Question 9 to Question 11. To include the scores of participants unable to complete the task in the assigned time, the final score was obtained by dividing the actual time used by the number of objectives successfully accomplished. A comparison was made between the prior levels of exposure to laparoscopy and E1 to E 3 scores to determine the construct validity of the model. Participants with previous exposure to a larger amount of laparoscopic procedures had higher E1 to E 3 scores in comparison to those with exposure to fewer procedures. All participants had a favorable opinion of the model for both testing and training purposes without inter-group differences. These findings clearly show that the LASTT model has face and construct validity, and may be a useful tool for training and evaluation of LPS among surgeons performing laparoscopic procedures.

Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator

The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand–eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparoscopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.

A valid model for testing and training laparoscopic psychomotor skills

This study aims to evaluate the face and construct validity of the Laparoscopic Skills Testing and Training (LASTT) model, developed by the European Academy of Gynaecological Surgery (EAGS) for assessing laparoscopic psychomotor skills (LPS). This study is designed based on the Canadian Task Force II-1. This study was conducted in workshops organised by the EAGS in 2008 and 2009. One hundred ninety-nine gynaecologists were classified in three groups according to their exposure to laparoscopy (G1: no/little, G2: intermediate, G3: important). Participants performed three repetitions of three exercises (E1: camera navigation, E2: hands–eyes coordination, E3: bimanual coordination) with measurable objectives to accomplish within a limited time frame. The face validity of the model was assessed by an 11-item questionnaire using a 10-cm visual analogue scale. Q1–Q8 evaluated its capacity for testing and training LPS and Q9–Q11 its relevance for actual laparoscopic surgery. The score of each exercise was obtained by dividing the time to correct performed exercise by the number of objectives effectively accomplished. The correlation between E1–E3 scores and the level of exposure to laparoscopy was evaluated, and the scores of the different groups were compared to assess the construct validity. Participants gave a favourable opinion about the model without inter-group differences. In E1–E3, the scores correlated with the level of previous exposure to laparoscopic procedures, more-experienced participants achieving better results than less-experienced participants. The data demonstrate the face and construct validity of the LASTT model, suggesting that it can be a useful tool for training and evaluation of LPS in surgical disciplines that perform laparoscopic procedures.

Feasibility and construct validity of a novel laparoscopic skills testing and training model

The apprentice–tutor model was useful for training surgeons for many years, but the complexity of surgical technology in the 21st century, especially endoscopic surgery, has exponentially increased the demands for surgical education. Therefore, more and more people now accept that endoscopic surgery, demanding as it requires specific skills, should also be taught outside the operating theatre. Although many systems, including animal models and simulators, have been proposed, an in-house structured and validated method for testing and training laparoscopic skills is missing in gynaecology. We have developed a laparoscopic skills testing and training (LASTT) model and performed two studies evaluating its feasibility and the construct validity of three different exercises (camera navigation, camera navigation and forceps handling, and forceps handling and bi-manual coordination), specifically selected to test and train laparoscopic psychomotor skills (LPS). In the first study, ten experts and 14 novices repeated each exercise between 20 and 30 times. The results demonstrated that the model is useful for testing and training laparoscopic skills. Clear learning curves were observed for both experts and novices, with better scores for the former at the beginning and the end of the study, proving the construct validity of the model. In the second study, 42 experts and 241 novices repeated each exercise three times during skill evaluation workshops organised by the European Academy of Gynaecological Surgery. The results confirmed the construct validity of the model. In conclusion, the LASTT model seems a cost-effective tool for providing an in-house program for continuous training and evaluation of LPS in all surgical disciplines in which laparoscopic procedures are, or might be, performed.

ASSESSMENT OF LAPAROSCOPIC PSYCHOMOTOR SKILLS IN INTERNS USING THE MIST VIRTUAL REALITY SIMULATOR: A PREREQUISITE FOR THOSE CONSIDERING SURGICAL TRAINING?

Selection for surgical training in Australia is currently based on assessment of a structured curriculum vitae, referral reports from selected clinicians and an interview. The formal assessment of laparoscopic psychomotor skill and ability to attain skills is not currently a prerequisite for selection. The aim of this study was to assess the innate psychomotor skills of interns and also to compare interns with an interest in pursuing a surgical career to interns with those with no interest in pursuing a surgical career. Twenty-two interns were given the opportunity to carry out tasks on the Minimal Invasive Surgical Trainer, Virtual Reality (Mentice, Gothenburg, Sweden) Simulator. The candidates were required to complete six tasks, repeated six times each. Scores for each task were calculated objectively by the simulator software. Demographic data were similar between the two groups. Although some candidates who were interested in pursuing a surgical career performed poorly on the simulator, there was no significant difference when comparing the two groups. The Minimal Invasive Surgical Trainer, Virtual Reality (Mentice) Simulator provides an objective and comparable assessment of laparoscopic psychomotor skills. We can conclude that interns have varying inherent ability as judged by the simulator and this does not seem to have an influence on their career selection. There was no significant difference in the scores between the two groups. Interns with and without inherent abilities have aspirations to pursue surgical careers and their aptitude does not seem to influence this decision. Surgical colleges could use psychomotor ability assessments to recruit candidates to pursue a career in surgery. Trainees needing closer monitoring and additional training could be identified early and guided to achieve competency.

A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill

Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes. The minimally invasive VR simulator (MIST-VR) has 12 abstract laparoscopic tasks, each at 3 graduated levels of difficulty (easy, medium, and hard). Twenty medical students completed 2 sessions of all tasks at the easy level, 10 sessions at the medium level, and finally 5 sessions of the 2 most complex tasks at the hard level. At the medium level, subjects were randomized into 2 equal groups performing either all 12 tasks (group A) or the 2 most complex tasks (group B). Performance was measured by time taken, path length, and errors for each hand. The results were compared between groups, and to those of 10 experienced laparoscopic surgeons. Baseline performance of both groups was similar at the easy level. At the medium level, learning curves for all 3 parameters reached plateau at the second (group A, P < .05) and sixth (group B, P < .05) repetitions. Performance at the hard level was similar between the 2 groups, and all achieved the pre-set expert criteria. A graduated laparoscopic training curriculum enables trainees to familiarise, train and be assessed on laparoscopic VR simulators. This study can aid the incorporation of VR simulation into established surgical training programmes.

Laparoscopic skills training and assessment

The introduction of laparoscopic techniques to general surgery was associated with many unnecessary complications, which led to the development of skills laboratories to train novice laparoscopic surgeons. This article reviews the tools currently available for training and assessment in laparoscopic surgery. Medline searches were performed to identify articles with combinations of the following key words: laparoscopy, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. Current training involves the use of box trainers with either innate models or animal tissues; it lacks objective assessment of skill acquisition. Virtual reality simulators have the ability to teach laparoscopic psychomotor skills, and objective assessment is now possible using dexterity-based and video analysis systems. The tools are now available for the development of a structured, competency-based, laparoscopic surgical training programme.