Development Of Laparoscopic Skills Research Articles

Effect of virtual reality training to enhance laparoscopic assistance skills

BackgroundWhile laparoscopic assistance is often entrusted to less experienced individuals, such as residents, medical students, and operating room nurses, it is important to note that they typically receive little to no formal laparoscopic training. This deficiency can lead to poor visibility during minimally invasive surgery, thus increasing the risk of errors. Moreover, operating room nurses and medical students are currently not included as key users in structured laparoscopic training programs.ObjectivesThe aim of this study is to evaluate the laparoscopic skills of OR nurses, clinical medical postgraduate students, and residents before and after undergoing virtual reality training. Additionally, it aimed to compare the differences in the laparoscopic skills among different groups (OR nurses/Students/Residents) both before and after virtual reality training.MethodsOperating room nurses, clinical medical postgraduate students and residents from a tertiary Grade A hospital in China in March 2022 were selected as participants. All participants were required to complete a laparoscopic simulation training course in 6 consecutive weeks. One task from each of the four training modules was selected as an evaluation indicator. A before-and-after self-control study was used to compare the basic laparoscopic skills of participants, and laparoscopic skill competency was compared between the groups of operating room nurses, clinical medical postgraduate students, and residents.ResultsTwenty-seven operating room nurses, 31 clinical medical postgraduate students, and 16 residents were included. The training course scores for the navigation training module, task training module, coordination training module, and surgical skills training module between different groups (operating room nurses/clinical medical postgraduate/residents) before laparoscopic simulation training was statistically significant (p < 0.05). After laparoscopic simulation training, there was no statistically significant difference in the training course scores between the different groups. The surgical level scores before and after the training course were compared between the operating room nurses, clinical medical postgraduate students, and residents and showed significant increases (p < 0.05).ConclusionOur findings show a significant improvement in laparoscopic skills following virtual surgery simulation training across all participant groups. The integration of virtual surgery simulation technology in surgical training holds promise for bridging the gap in laparoscopic skill development among health care professionals.

Assessment of Basic Laparoscopic Skills for Surgical Residents on Simulation Based Endotrainer

INTRODUCTION Minimal invasive surgery revolution has bestowed surgeons the power to gain maximum access in surgical area of interest while inflicting minimal trauma. Simulator based training develops cognitive and psychomotor skills which identifies the limitations and strength of learner. AIM To assess the role of endotrainer for development of laparoscopic skills amongst surgical residents. MATERIALS AND METHODS A structured endotrainer program was conducted among 18 surgical residents for a period of 2 months from May – July22 in the department of general surgery in RRMCH, Bangalore, consisting of various tasks which each resident performed regularly for 2 months. The tasks performed were evaluated by a mentor on the basis of Global Rating Scale and the time taken to perform each task and feedback was taken from the subjects. RESULTS T test for 2 dependent mean using SPSS version23 with P value of &lt;0.05 was considered significant. Significant improvement observed in the performance of each participant from DAY1 to DAY30 and further to DAY60 both with respect to time taken as well as GRS score. Day 1, Day 30 and Day 60 GRS mean percentage growth exhibits 45% to 75% to 80% respectively. CONCLUSION Short term training not only proved to show significant improvement in the cognitive performance alongside exploring feedbacks, limitations and building perseverance. We conclude that simulation based training is the need of the hour in this laparoscopy era and should be incorporated as a compulsory module in the curriculum of postgraduate training.

Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes

BackgroundTo determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners. Methods74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. ResultsMean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores. ConclusionsOur study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.

8033 Development of Laparoscopic Skills in Skills-Naïve Trainees Using Self-Directed Learning with Take-Home Laparoscopic Trainer Boxes

<h3>Study Objective</h3> Our study aims to evaluate the utility of take-home laparoscopic trainer boxes with self-directed learning in the development of laparoscopic skills in medical students and surgically naïve gynecology interns. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> Tertiary care university hospital. <h3>Patients or Participants</h3> 74 medical students and beginning OB/Gyn interns (postgraduate year 1). <h3>Interventions</h3> Participants performed a laparoscopic peg transfer task with only task instructions and no additional training. Tasks were recorded and scored by adding completion time to penalties for dropped pegs. Participants subsequently took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the peg transfer task for a final score. <h3>Measurements and Main Results</h3> Initial and final peg transfer scores were compared for improvement. Improvement was compared to practice as well as variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. Mean peg transfer task scores improved from 287 seconds to 193 seconds (p<0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R² of 0.134 (p=0.001). More practice, both in time and number of sessions, resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R² of 0.152 (p<0.001). Medical students interested in surgery had less practice sessions (p=0.496), however, interest in a surgical field had no impact on final scores or improvement. Playing a musical instrument and having two or more hobbies involving manual dexterity was associated with a better baseline score (p=0.032 and p=0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted initial or final scores. <h3>Conclusion</h3> Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.

We live in a virtual world: Training the trainee using an integrated visual reality simulator curriculum

BackgroundGynaecology trainees struggle to obtain adequate procedural experience. Training programs integrating virtual reality simulators (VRS) have been suggested as a solution.AimsThe study aimed to assess if a VRS training program (LapSim®, Surgical Sciences, Göteborg, 2017) improved live operating performance at six months for novice and experienced trainees. Additional outcomes included the association between LapSim® logged time and live operating performance at six months, LapSim® scores and live operating performance at zero and sixmonths and the difference in benefit for novice and experienced gynaecology trainees.MethodsA prospective intervention study was conducted. Novice and experienced trainees were enrolled, and comparisons made at zero‐ and six‐month time points. The intervention groups were provided with a laparoscopic gynaecology curriculum incorporating VRS. Controls underwent routine training only. Assessment of live operating performance was conducted after six months training.ResultsThirty‐five trainees participated, and 25 had access to the VRS curriculum (17 novice and eight experienced trainees). Access to the VRS curriculum and time spent training on the LapSim® made no difference to live operating ability for either intervention group (P > 0.05). The median (interquartile range) hours of VRS usage were 7.9 (4.5–10.8) and 6.0 (4.0–6.8) for novice and experienced trainees respectively. The intervention group provided positive feedback on the utility of VRS in their laparoscopic skill development.ConclusionOptimal utilisation of VRS in Australian training paradigms remains incompletely understood. Further research is required to establish the most effective integration of VRS into training models to ensure uptake and transferability to the operating theatre.

The application of virtual reality simulators in laparoscopic surgery training (a review)

Introduction: The last decade saw a significant introduction of minimally invasive surgery into medical practice. Laparoscopy has even become the gold standard for some interventions. This has led to an increased demand for qualified specialists. The acquisition of laparoscopic surgery skills entrains a time investment both on part of the trainee and the instructor. The need for an accelerated development of specific psycho-motor perceptions which are a requirement for the execution of laparoscopic procedures, led to the establishment of virtual reality simulator training. For the first time in Bulgaria, in 2016, the Medical University of Varna introduced formal education via the way of virtual reality laparoscopic simulators. They permit the development of laparoscopic skills even at the level of a medical student. Aim: The aim of the article is to analyze the efficiency of existing virtual reality simulators and their application in laparoscopic surgery training. Materials and Methods : А systematic literature analysis was performed via the databases PubMed , Web of Science , Scopus and Google Scholar using various combinations of the following keywords: “simulation”, “virtual*”, “VR”, “laparoscopic*”, “surgery”, “education”, “LapMentor”, “LapSim”, for articles published in the past 10 years. The keywords were in combination with Boolean operators “and”, “or”. After a thorough review of all pertinent articles the most relevant publications were selected. Results: The electronic inquiry yielded 106 articles in total. After the application of suitable inclusion and exclusion criteria, 98 of them were deemed unfit, leaving 8 randomized control trials. To meet the inclusion criteria, the publications needed to be systemized random prospective studies regarding virtual reality simulators in laparoscopic surgery. Conclusion: Advancements in the field of surgery follow closely the introduction of new technologies. This leads to the need for a change of traditional surgery training practices. The need of laparoscopic surgery specialists becomes greater with every passing year. The new generation of virtual reality simulators provides a complete set of basic skill procedures and complete operative procedures. Due to their limitless repeatability, an expert level of proficiency is able to be reached in a relatively short period of time. The surgical community must take note of the practices that have already been adopted by aviation training and introduce mandatory laparoscopic surgery training programs, which all specialists must undergo before undertaking procedures in the operating theater.

Effect of video games playing on surgical simulation training: a systematic review.

Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. This study aims to systematically review the existing evidence. A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.

The development of laparoscopic skills using virtual reality simulations: A systematic review.

Teaching based on virtual reality simulators in medicine has expanded in recent years due to the limitations of more traditional methods, especially for surgical procedures such as laparoscopy. To analyze the effects of using virtual reality simulations on the development of laparoscopic skills in medical students and physicians. The literature screening was done in April 2020 through Medline (PubMed), EMBASE and Database of the National Institute of Health. Randomized clinical trials that subjected medical students and physicians to training in laparoscopic skills in virtual reality simulators. Paired reviewers independently identified 1529 articles and included 7 trials that met the eligibility criteria. In all studies, participants that trained in virtual simulators showed improvements in laparoscopic skills, although the articles that also had a physical model training group did not show better performance of one model compared to the other. No article beyond 2015 met the eligibility criteria, and the analyzed simulators have different versions and models, which might impact the results. Virtual reality simulators are useful educational tools, but do not show proven significant advantages over traditional models. The lack of standardization and a scarcity of articles makes comparative analysis between simulators difficult, requiring more research in the area, according to the model suggested in this review. Registered by the Prospective Register of Systematic Reviews (PROSPERO), identification code CRD42020176479.

Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study.

BackgroundSurgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents’ motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training.ObjectiveThe aim of this study was to establish construct validity for the laparoscopic serious game Underground.MethodsAll study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience.ResultsControlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable.ConclusionsWe established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.

2967 Development of Laparoscopic Skills for Myomectomy in the Uterine Model

Video Objective To demonstrate the importance of the development of laparoscopic skills in surgeons in training, before facing real scenarios, specifically in uterine myomatosis. Setting In the gynecological endoscopy service of the Central Sur Hospital of High Specialty, residents have developed an anatomical model of the uterus, with in different locations. Interventions Initially a positive mold is made, made of ceramic, which will serve as the basis for the next mold, negative, in cement, it is left to dry and as a final step, it is used for the deposit of silicone and latex, introducing the fibroids , Made with a harder texture. The development of the practice allows to emulate as real as possible, a myomectomy. Conclusion Fibroids are the most frequent benign gynecological tumors in women. They affect women of childbearing age, by 20-30%, their treatment is usually surgical and laparoscopic, the approach of choice. Myomas represent a surgical challenge, even for the expert surgeon, because the presentation is varied: in quantity and location. The previous practice, in anatomical models, has proven to be very useful in the development and improvement of surgical skills in minimally invasive procedures.

Development of Laparoscopic Skills in Medical Students - What Makes the Difference?

Development of Laparoscopic Skills in Medical Students - What Makes the Difference?

Clip-stone and T clip-sinus: A clinical analysis of six cases on migration of clips and literature review from 1997 to 2017.

Introduction:With the development of laparoscopic skills, the laparoscopic common bile duct exploration (LCBDE) and laparoscopic cholecystectomy (LC) has become the standard surgical procedure for choledocholithiasis. We usually use Hem-o-lok clips to control cystic duct and vessels, which is safe on most occasions and has few perioperative complications such as major bleeding, wound infection, bile leakage, and biliary and bowel injury. However, a rare complication of post-cholecystectomy clip migration (PCCM) increases year by year due to the advancement and development of LC, CBD exploration as well as the wide use of surgical ligation clips.Materials and Methods:Six patients whose clips are found dropping into CBD or forming T-tube sinus after laparoscopic surgery in our department.Results:Six patients whose clips are found dropping into CBD (clip-stone) (3/6) or forming T-tube sinus (T clip-sinus) (3/6) after LCBDE or LC.Conclusions:PCCM is a rare but severe complication of LCBDE. A pre-operative understanding of bile duct anatomy, the use of the minimum number of clips and the harmonic scalpel during the surgeries is necessary. Considering clip-stone or clip-sinus in the differential diagnosis of patients with biliary colics or cholangitis after LCBDE even years after surgery, the detailed medical history and pre-operative examination are inevitable, especially for these patients who had undergone LCBDE.

Playing to your skills: a randomised controlled trial evaluating a dedicated video game for minimally invasive surgery.

Video gaming demands elements of visual attention, hand-eye coordination and depth perception which may be contiguous with laparoscopic skill development. General video gaming has demonstrated altered cortical plasticity and improved baseline/acquisition of minimally invasive skills. The present study aimed to evaluate for skill acquisition associated with a commercially available dedicated laparoscopic video game (Underground) and its unique (laparoscopic-like) controller for the Nintendo®Wii U™ console. This single-blinded randomised controlled study was conducted with laparoscopically naive student volunteers of limited (< 3h/week) video gaming backgrounds. Baseline laparoscopic skills were assessed using four basic tasks on the Virtual Reality (VR) simulator (LAP MentorTM, 3D systems, Colorado, USA). Twenty participants were randomised to two groups; Group A was requested to complete 5h of video gaming (Underground) per week and Group B to avoid gaming beyond their normal frequency. After 4weeks participants were reassessed using the same VR tasks. Changes in simulator performances were assessed for each group and for intergroup variances using mixed model regression. Significant inter- and intragroup performances were present for the video gaming and controls across four basic tasks. The video gaming group demonstrated significant improvements in thirty-one of the metrics examined including dominant (p ≤ 0.004) and non-dominant (p < 0.050) instrument movements, pathlengths (p ≤ 0.040), time taken (p ≤ 0.021) and end score [p ≤ 0.046, (task-dependent)]. The control group demonstrated improvements in fourteen measures. The video gaming group demonstrated significant (p < 0.05) improvements compared to the control in five metrics. Despite encouraged gameplay and the console in participants' domiciles, voluntary engagement was lower than directed due to factors including: game enjoyment (33.3%), lack of available time (22.2%) and entertainment distractions (11.1%). Our work revealed significant value in training using a dedicated laparoscopic video game for acquisition of virtual laparoscopic skills. This novel serious game may provide foundations for future surgical developments on game consoles in the home environment.

ОПЫТ ИСПОЛЬЗОВАНИЯ ОРИГИНАЛЬНОГО ВИДЕОТРЕНАЖЕРА ДЛЯ ОСВОЕНИЯ БАЗОВЫХ НАВЫКОВ В ЛАПАРОСКОПИЧЕСКОЙ ХИРУРГИИ

Introduction. For development of laparoscopic skills, box training simulators and virtual computer simulators of different complexity are used as training tools. All of them have advantages and disadvantages. Objective. To study the possibility and efficiency of department-created original video simulator for providing basic laparoscopic skills to students. Material and methods. The study was performed on the original laparoscopic video simulator with the participation of 42 students of the 6th year of studying. The digital data processed using the parametric methods of statistical analysis. Results. Exercises after two training gave a significant improvement on the criterion of speed (time). Subjectively, most of participants began to perform them more clearly and confidently, the number of unnecessary movements and mistakes decreased. Conclusions. The laparoscopic simulator is effective for training of basic endovideosurgical manipulations and can be used in educational process by the senior students at a preliminary stage before classes on simulator of virtual reality.

Retention of laparoscopic skills in naive medical students who underwent short training.

Simulators are useful tools in the development of laparoscopic skills. However, little is known about the effectiveness of short laparoscopic training sessions and how retention of skills occurs in surgical trainees who are naïve to laparoscopy. This study analyses the retention of laparoscopic surgical skills in medical students without prior surgical training. A group of first- and second-year medical students (n=68), without prior experience in surgery or laparoscopy, answered a demographic questionnaire and had their laparoscopic skills assessed by the Fundamentals of Laparoscopic Surgery (FLS) training protocol. Subsequently, they underwent a 150-minute training course after which they were re-tested. One year after the training, the medical students' performance in the simulator was re-evaluated in order to analyse retention. Of the initial 68 students, a total of 36 participated throughout the entire study, giving a final participation rate of 52%. Thirty-six medical students with no gender predominance and an average age of 20years were evaluated. One year after the short training programme, retention was 69.3% in the peg transfer (p<0.05) and 64.2% in ligature (p<0.05) compared with immediate post-training evaluation. There was no significant difference in suturing. The average sample score in the baseline test was 8.3, in the post-training test it was 89.7, and in the retention test it was 84.2, which corresponded to a skill retention equivalence of 93%. There was a significant retention of the laparoscopic surgical skills developed. Even 1year after a short training session, medical students without previous surgical experience showed that they have retained a great part of the skills acquired through training.

MP12-11 A NOVEL PATHOLOGY RELATED TO SUBCAPSULAR ALDOSTERONE-PRODUCING CELL CLUSTERS CAUSES HYPERALDOSTERONISM

INTRODUCTION AND OBJECTIVES: The development of laparoscopic skills requiresexperiencewith a certain numberof cases. The learningcurveof thesurgeon inacquiring laparoscopicskillswasexamined in over 300 cases of retroperitoneal laparoscopic adrenalectomy. METHODS: The study included 318 retroperitoneal laparoscopic adrenal tumor cases performed between 2006 and 2015 at Chiba University Hospital. Duration of operation, bleeding, and complications were analyzed by review of the operation records. MannWhitney U test and Student t-test were used for statistical analysis. RESULTS: The mean age of patients was 55 (22-78) years. There were 183 left(Lt) and 133 right(Rt) adrenal tumors. Average tumor size was 23 (0-115) mm. Clinical manifestations included primary aldosteronism(APA) (129 cases), Cushing syndrome (49 cases), subclinical Cushing syndrome(SCS) (68 cases), APA+SCS(20 cases), pheochromocytoma (10 cases), and other tumors (43 cases). The median operation time was 168 minutes (min). The conversion rate to open surgery was 1.6%. Depend on the side of the operation, no significant difference were observed in operation time (Lt 177min, Rt 182min, P1⁄40.235), while significant difference were observed in amount of bleeding (Lt 99ml, Rt 42ml, P1⁄40.0436). When divide generation of operator by 5 years, although no significant difference were observed in operation time(175-187min), amount of bleeding significantly reduced by the generation, such as for 1st, 2nd, 3ird, 4irth generation was, 166, 81, 38 and 41 ml. In terms of cases need to be stabilize, most significant cutoff was first 20 cases. The mean operation time significantly decreased by 21 min before and after 20 cases (196min and 175min, respectively) (P1⁄40.0043). On the other hand, the mean operation time of each surgeon was not proportional to the number of operations the surgeon had performed. CONCLUSIONS: Although the learning curves of laparoscopic adrenalectomy differed by surgeon, 20 cases seems to be a cut-off to acquire stable surgical skills.

Accelerometer Measurement of Head Movement During Laparoscopic Surgery as a Tool to Evaluate Skill Development of Surgeons

To detect and measure surgeons' head movement during laparoscopic simulator performance to determine whether expert surgeons have economy of motion in their head movement, including change of direction, compared with intermediate and novice surgeons. We investigated head movement as an objective tool for assessment of laparoscopic surgical skill and its potential use for assessing novice surgeons' progress on the learning curve. After obtaining institutional review board approval, medical students, urology residents, and attending staff surgeons from an academic institution were recruited. Participants were grouped by level of experience and performed tasks on the Electronic Data Generation for Evaluation laparoscopic simulator. Surgeons wore a commercially available wireless electroencephalogram monitor as a flexible, adjustable, and lightweight headband with 7 sensors-2 forehead sensors, 2 ear sensors, and 3 reference sensors. The headband incorporates a 3-axis accelerometer enabling head movement quantification. A variance analysis was used to compare the average head movement acceleration data between each group. Tulane University Medical Center, New Orleans, LA, an academic medical center and the principal teaching hospital for Tulane University School of Medicine. A total of following 19 participants were recruited for the study and stratified by surgical experience into novice (n = 6), intermediate (n = 9), and expert (n = 4) laparoscopy groups: 6 medical students, 9 urology residents (postgraduate years 1 to5), and 4 attending urologists, respectively. Analysis of the average acceleration rate of head movement showed statistically significant differences among groups on both the vertical axis (p = 0.006) and horizontal axis (p = 0.018) in the laparoscopic suturing task. This demonstrated the ability to distinguish between experts and novice laparoscopic surgeons. The average acceleration among groups did not demonstrate statistical significance on the vertical axis (p = 0.078) and horizontal axis (p = 0.077) in the peg transfer task. This may be in response to the ease of the task. The analysis of the forward-backward axis or depth perception also showed no significant differences between groups. Accelerometer-based motion analysis of head movement appears to be a useful tool to evaluate laparoscopic skill development of surgeons in terms of their economy of motion, and it could potentially be used for ergonomic assessment of training in the future, and progression on the learning curve.

Performance Variables and Professional Experience in Simulated Laparoscopy: A Two-Group Learning Curve Study

Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills. A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values. Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course. Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.

Laparoscopic surgery skills evaluation: analysis based on accelerometers.

Background and Objective:Technical skills assessment is considered an important part of surgical training. Subjective assessment is not appropriate for training feedback, and there is now increased demand for objective assessment of surgical performance. Economy of movement has been proposed as an excellent alternative for this purpose. The investigators describe a readily available method to evaluate surgical skills through motion analysis using accelerometers in Apple's iPod Touch device.Methods:Two groups of individuals with different minimally invasive surgery skill levels (experts and novices) were evaluated. Each group was asked to perform a given task with an iPod Touch placed on the dominant-hand wrist. The Accelerometer Data Pro application makes it possible to obtain movement-related data detected by the accelerometers. Average acceleration and maximum acceleration for each axis (x, y, and z) were determined and compared.Results:The analysis of average acceleration and maximum acceleration showed statistically significant differences between groups on both the y (P = .04, P = .03) and z (P = .04, P = .04) axes. This demonstrates the ability to distinguish between experts and novices. The analysis of the x axis showed no significant differences between groups, which could be explained by the fact that the task involves few movements on this axis.Conclusion:Accelerometer-based motion analysis is a useful tool to evaluate laparoscopic skill development of surgeons and should be used in training programs. Validation of this device in an in vivo setting is a research goal of the investigators' team.

WII “Trauma Centre” VS. LapSim: Are modern game consoles comparable to simulators for the development of laparoscopic skills?

WII “Trauma Centre” VS. LapSim: Are modern game consoles comparable to simulators for the development of laparoscopic skills?