Minimally Invasive Surgical Trainer-Virtual Reality Research Articles

Trainee Performance After Laparoscopic Simulator Training Using a Blackbox versus LapMentor

BackgroundTraining using laparoscopic high-fidelity simulators (LHFSs) to proficiency levels improves laparoscopic cholecystectomy skills. However, high-cost simulators and their limited availability could negatively impact residents’ laparoscopic training opportunities. We aimed to assess whether motivation and surgical skill performance differ after basic skills training (BST) using a low-cost (Blackbox) versus LHFS (LapMentor) among medical students. Materials and methodsSixty-three medical students from Karolinska Institutet volunteered, completing written informed consent, questionnaire regarding expectations of the simulation training, and a visuospatial ability test. They were randomized into two groups that received BST using Blackbox (n = 32) or LapMentor (n = 31). However, seven students absence resulted in 56 participants, followed by another 9 dropouts. Subsequently, after training, 47 students took up three consecutive tests using the minimally invasive surgical trainer–virtual reality (MIST-VR) simulator, finalizing a questionnaire. ResultsMore Blackbox group participants completed all MIST-VR tests (29/31 versus 18/25). Students anticipated mastering LapMentor would be more difficult than Blackbox (P = 0.04). In those completing the simulation training, a trend toward an increase was noted in how well participants in the Blackbox group liked the simulator training (P = 0.07). Subgroup analysis of motivation and difficulty in liking the training regardless of simulator was found only in women (Blackbox [P = 0.02]; LapMentor [P = 0.06]). In the Blackbox group, the perceived difficulty of training, facilitation, and liking the Blackbox training (significant only in women) were significantly correlated with the students’ performance in the MIST-simulator. No such correlations were found in the LapMentor group. ConclusionsResults indicate an important role for low-tech/low-cost Blackbox laparoscopic BST of students in an otherwise high-tech surrounding. Furthermore, experience of Blackbox BST procedures correlate with students’ performance in the MIST-VR simulator, with some gender-specific differences.

Persistent Next-Day Effects of Excessive Alcohol Consumption on Laparoscopic Surgical Performance

To examine the effect of previous-day excessive alcohol consumption on laparoscopic surgical performance. Study 1 was a randomized controlled trial. Study 2 was a cohort study. Surgical skills laboratory. Sixteen science students (laparoscopic novices) participated in study 1. Eight laparoscopic experts participated in study 2. All participants were trained on the Minimally Invasive Surgical Trainer Virtual Reality (MIST-VR). The participants in study 1 were randomized to either abstain from alcohol or consume alcohol until intoxicated. All study 2 subjects freely consumed alcohol until intoxicated. Subjects were assessed the following day at 9 am, 1 pm, and 4 pm on MIST-VR tasks. Assessment measures included time, economy of diathermy use, and error scores. In study 1, both groups performed similarly at baseline, but the alcohol group showed deterioration on all performance measures after alcohol consumption. Overall, although the time score differences between the 2 groups were not statistically significant (P = .29), there was a significant difference between the 2 groups' diathermy (P < .03) and error (P < .003) scores. There was also a significant effect for time of testing (P < .003), diathermy (P < .001), and errors (P < .001). In study 2, experts demonstrated a similar postalcohol performance decrement for time (P < .02), diathermy (P < .001), and error scores (P < .001). Excessive consumption of alcohol appeared to degrade surgical performance the following day even at 4 pm, suggesting the need to define recommendations regarding alcohol consumption the night before assuming clinical surgical responsibilities.

56. Proficiency at the end of practice predicts retention of a technical clinical skills

A debate is emerging regarding the efficacy of proficiency based versus duration based training of technical skills. It is not clear whether the performance level attained at the end of practice (i.e., proficiency criteria), or the overall amount of practice performed during learning will best predict the retention of a technical clinical skill. &#x0D; The skill learned was the single-handed double square-knot. Forty two trainees learned the skill through video-based instruction and were divided into three groups (14 participants per group) each with a specific criterion time to tie the knot (10, 15, and 20 seconds). Practice continued until participants completed the knot within their criterion time. The total number of trials, and the overall practice time required to obtain each respective criterion were recorded during practice. Participants returned one-week later for a timed retention test consisting of one trial of the knot tying skill with no video instruction.&#x0D; A multiple regression analysis tested whether the amount of practice, the total practice time, or the criterion reached at the end of practice was the best predictor of the time taken to perform the skill during retention. This analysis showed that the number of practice trials was highly correlated with total practice time (r = .82, p = .01), therefore total practice time was withdrawn as a predictor variable from the subsequent analysis. The regression showed that the only significant predictor of retention performance was the criterion reached at the end of practice (p = .03). The number of practice trials was not found to significantly predict the retention performance (p = .87).&#x0D; The results support the notion that proficiency based training results in better retention of a technical clinical skill in comparison to duration based approaches. This provides evidence for the introduction of proficiency based educational approaches in technical skills curricula.&#x0D; Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Surgical skill acquisition with self-directed practice using computer-based video training. Am J Surg. 2007; 193(2):237-42. &#x0D; Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005; 241(2):364-72. &#x0D; Van Sickle KR, Ritter EM, McClusky DA, Lederman A, Baghai M, Gallagher AG, Smith CD. Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study. Surg Endosc. 2007; 21(1):5-10.

Visual working memory influences the performance in virtual image–guided surgical intervention

This study addresses for the first time the relationship between working memory and performance measures in image-guided instrument navigation with Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) and GI Mentor II (a simulator for gastroendoscopy). In light of recent research on simulator training, it is now prime time to ask why in a search for mechanisms rather than show repeatedly that conventional curriculum for simulation training has effect. The participants in this study were 28 Swedish medical students taking their course in basic surgery. Visual and verbal working memory span scores were assessed by a validated computer program (RoboMemo) and correlated with visual-spatial ability (MRT-A test), total flow experience (flow scale), mental strain (Borg scale), and performance scores in manipulation and diathermy (MD) using Procedicus MIST-VR and GI Mentor 11 (exercises 1 and 3). Significant Pearson's r correlations were obtained between visual working memory span scores for visual data link (a RoboMemo exercise) and movement economy (r = -0.417; p < 0.05), total time (r = -0.495; p < 0.01), and total score (r = -0.390; p < 0.05) using MIST-MD, as well as total time (r = -0.493; p < 0.05) and efficiency of screening (r = 0.469; p < 0.05) using GI Mentor 11 (exercise 1). Correlations also were found between visual working memory span scores in rotating data link (another RoboMemo exercise) and both total time (r = -0.467; p < 0.05) and efficiency of screening (r = -0.436; p < 0.05) using GI Mentor 11 (exercise 3). Significant Pearson's r correlations also were found between visual-spatial ability scores and several performance scores for the MIST and GI Mentor II exercises. Findings for the first time demonstrate that visual working memory for surgical novices may be important for performance in virtual simulator training with two well-known and validated simulators.

Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR) learning center study

The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) has been well validated as a training device for laparoscopic skills. It has been demonstrated that training to a level of proficiency on the simulator significantly improves operating room performance of laparoscopic cholecystectomy. The purpose of this project was to obtain a national standard of proficiency using the MIST-VR based on the performance of experienced laparoscopic surgeons. Surgeons attending the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2004 Annual Scientific Meeting who had performed more than 100 laparoscopic procedures volunteered to participate. All the subjects completed a demographic questionnaire assessing laparoscopic and MIST-VR experience in the learning center of the SAGES 2004 meeting. Each subject performed two consecutive trials of the MIST-VR Core Skills 1 program at the medium setting. Each trial involved six basic tasks of increasing difficulty: acquire place (AP), transfer place (TP), traversal (TV), withdrawal insert (WI), diathermy task (DT), and manipulate diathermy (MD). Trial 1 was considered a "warm-up," and trial 2 functioned as the test trial proper. Subject performance was scored for time, errors, and economy of instrument movement for each task, and a cumulative total score was calculated. Trial 2 data are expressed as mean time in seconds in Table 2. Proficiency levels for laparoscopic skills have now been established on a national scale by experienced laparoscopic surgeons using the MIST-VR simulator. Residency programs, training centers, and practicing surgeons can now use these data as guidelines for performance criterion during MIST-VR skills training.

P-456: Novices outperform experienced laparoscopists in Virtual Reality laparoscopy simulator

Virtual Reality has emerged as a potential method to both assess surgeon skill level and improve surgical performance. The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) laparoscopic trainer has been validated as a method to improve operating room (OR) performance in gallbladder bed dissection among general surgery residents, yet little work has been done among gynecologic surgeons. The purpose of this study was to assess the use of the MIST-VR trainer for proficiency-based laparoscopic skills training among surgeons and trainees not previously exposed to virtual laparoscopic simulators.

Effects of Cognitive Distraction on Performance of Laparoscopic Surgical Tasks

To quantify the effects of cognitive distraction on surgical task performance in residents and medical students using a laparoscopic surgical simulator. Within-subjects design. A surgical skills laboratory. Thirteen surgical residents and medical students who volunteered for the study. Subjects performed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), under two different conditions (distracted and undistracted). Task order remained the same for all subjects, but the order of distraction was counterbalanced. In the distracted condition, distractions consisted of mental arithmetic problems posed sequentially so that subjects were continually distracted. Time to task completion, surgical errors committed, economy of motion, and overall performance scores were generated by the MIST-VR program software. Arithmetic error was not a factor in the overall performance score. Time to task completion was significantly greater when subjects were distracted for all six tasks performed. Overall score and economy of motion were negatively affected by distraction but the effect did not reach th level of statistical significance. There was no effect of distract on surgical errors. Cognitive distraction appears to negatively influence the performance of laparoscopic surgical tasks by increasing task completion time. Further study is required to determine what the effects would be on experienced surgeons and actual surgical outcomes.

Evaluation of target scores and benchmarks for the traversal task scenario of the minimally invasive surgical trainer-virtual reality (MIST-VR) laparoscopy simulator

The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) simulator is validated for laparoscopy training, but benchmarks and target scores for assessing single tasks are needed. Control data for the MIST-VR traversal task scenario were collected from 61 novices who performed the task 10 times over 3 days (1 h daily). Data were collected on the time taken, error score, economy of movement, and total score. Test differences were analyzed through percentage scores and t-tests for paired samples. Improvement was greatest over tests 1 to 5 (improvement: test(1.2), 38.07%; p = 0.000; test(4.5), 10.66%; p = 0.010): between tests 5 and 10, improvement slowed and scores stabilized. Variation in participants' performance fell steadily over the 10 tests. Trainees should perform at least 10 tests of the traversal task-five to get used to the equipment and task (automation phase; target total score, 95.16) and five to stabilize and consolidate performance (test 10 target total score, 74.11).

Night Call Does Not Impair Learning of Laparoscopic Skills

Investigators have looked at the effect of night call on surgical residents but not at learning of laparoscopic skills. The Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) tests 6 tasks similar to a laparoscopic cholecystectomy. We hypothesized that night call would impair laparoscopic performance and that skills would not improve but rather deteriorate after night call. Seventeen volunteers were tested before and after night call. Data collected included economy of movement, time, and number of errors for each hand/foot. A paired Student t test was used for statistical analysis. On the first 2 tasks, there was an improvement in all parameters post-call, with significance reached in 5 of 18 parameters (P<or=.05). In the "running of the bowel,'' 8 of 9 parameters were significantly improved (P<or=.05). In the final task, 9 of 11 parameters showed a deterioration post-call, but only economy of movement of the foot was significant (P<or=.05). Most parameters (16) showed improvement rather than deterioration post-call, which is consistent with learning of laparoscopic skills despite lack of sleep from night call.

The impact of sleep deprivation on product quality and procedure effectiveness in a laparoscopic physical simulator: a randomized controlled trial

Background To compare the impact of sleep deprivation after 24-hour duty (post-call) with that of 8-hour work (post-work) on product quality (PQ) and procedure effectiveness (PE) in a laparoscopic physical simulator. Methods Voluntary surgeons and nurses were pretested with the Epworth Sleepiness Scale (ESS) and Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Surgical task was suturing perforated ulcer on a foam stomach in a physical simulator. PQ and PE were measured by accuracy error (AE), tissue damage (TD) leak rate (LR), goal- (GDA) non-goal-directed actions (NGDA), and operating time (OT), respectively. Construct validity was assessed comparing measures when surgeons and nurses performed the surgical task. Inter-rater reliability (IRR) was assessed by Kendall’s tau b coefficient. An 80% power parallel block randomization design at alpha = .05 required 60 subjects. Results Thirty-two post-call surgeons and 32 post-work surgeons were well matched for age, gender, practice duration, and ESS and MIST-VR scores. The amount of time slept in the previous 24 hours was 1.5 versus 6.5 hours ( P < .05). AE (1.0 mm vs. .5 mm), TD (2.18 mm vs. 2.18 mm), LR (56.2% vs. 65.6%), GDA (33.5 vs. 32.5), NGDA (.56 vs. .31), and OT (381.0 seconds vs. 364.5 seconds) were not significantly different when 32 surgeons in the post-call arm were compared with their 32 counterparts in the post-work arm, respectively. Construct validity was shown by significant improvement in 4 outcome measures (AE 1.0 mm vs. 2.0 mm, P = .00001; GDA 32.5 vs. 39.0, P = .07, NGDA .43 vs. .96, P = .045; and OT 377.5 vs. 557.0, P = .0005) when 64 surgeons performed the task as compared to 64 nurses. Tau b for IRR was 1.0 ( P < .0001) for AE, TD, LR, and OT, .75 ( P = .325) for GDA, and .77 ( P = .305) for NGDA. Conclusions Sleep deprivation had no impact on the studied outcome measures of a surgical task performed in a laparoscopic simulator.

Cyber visual training as a new method for the mastery of endoscopic surgery

We devised a new method incorporating cyber visual training whereby novices in endoscopic surgery are instructed via repetition of a video-recorded procedure. We then conducted a study designed to investigate the impact of this cyber visual training on the mastery of intracorporeal knot-tying as an endoscopic technique. For the cyber visual training a 10-min video of the same procedure was replayed at normal, slow, and rapid speeds or presented in a series of still images. The training was undertaken by 36 medical students and 1st year trainee doctors who had had no experience of endoscopic surgery. They were divided into three groups, each of all received the same introductory lecture. Group A was only given training with the instructor for 15 min. Group B trained with the instructor for 15 min and was allowed self-training for 10 min. Group C viewed the cyber video beforehand and then underwent training with the instructor for 15 min. For all participants, the time required to complete a knot-tying task was measured and the level of endoscopic skill before and after the training was assessed using a virtual reality system the minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR), in terms of the following three parameters: time, errors, and efficiency of hand movements. The Steel-Dwass test was used to evaluate the differences among the three groups in task performance. Group C completed the knot-tying task faster than group A (p = 0.0375), but there were significant differences between groups A and B and groups B and C. There were no significant differences in the parameters assessed using the MIST-VR. Our new concept of cyber visual training is effective for mastering the knot-tying technique. This type of training should be widely applicable to other procedures, such as dissection, clipping, and hemostasis.

Assessment of Construct Validity of the Endoscopic Sinus Surgery Simulator

To study the relationship between performance on an endoscopic sinus surgery simulator (ES3) and fundamental perceptual, visuospatial, and psychomotor abilities. Validation study. Tertiary care medical center. Thirty-four medical students and 4 otolaryngology residents voluntarily enrolled. Subjects performed tasks on the ES3, minimally invasive surgical trainer virtual reality (MIST-VR), pictorial surface orientation (PicSOr), and 3 visuospatial tests (cube comparison, card rotation, and map planning). The MIST-VR was scored for time, task error, economy of hand movement, economy of diathermy, and total score. Scores were generated for the PicSOr task and visuospatial tests. Scores were correlated with time, accuracy, and total subscore on navigation, injection, and dissection tasks, as well as hazard score and total trial score on the ES3. The PicSOr score was statistically significantly correlated with the hazard score on the ES3 (r = 0.50, P < .001). Cube comparison (r = 0.43, P < .01) and card rotation (r = 0.45, P < .01) scores correlated significantly with the ES3 trial score, as did the MIST-VR total score and the ES3 trial score (r = 0.57, P < .001). In a multiple regression model, the PicSOr, cube comparison, and MIST-VR total scores were statistically significant predictors of ES3 performance (r = 0.63, P < .01). Scores on the ES3 correlate strongly with scores on previously validated measures of perceptual, visuospatial, and psychomotor performance. The ES3 provides a reliable assessment of factors that are important to the acquisition of minimally invasive surgical skills, demonstrating construct validity.

Validation of a six-task simulation model in minimally invasive surgery

The content validity of currently available inanimate simulation models is questionable, because some tasks seem too far from clinical reality. The aim of this study was to validate a simulation model with six tasks commonly used in clinical practice (6-TSM) for the acquisition of psychomotor skills in minimally invasive surgery (MIS). This was a prospective randomized trial comparing the 6-TSM to a previously described three-task training method (3-TTM). All first, second, and third postgraduate year surgical residents were eligible. The 6-TSM included clipping and dividing of a vessel, excision of lesion, appendectomy, mesh repair, suturing perforation, and hand-sewn anastomosis. The outcome measures of 6-TSM included accuracy error, tissue damage, sliding knot, leak, operating time, and dangerous movements. After completion of training, 6-TSM and 3-TTN residents were tested by the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR). Criterion-related and construct validity, responsiveness, test-retest, and interrater reliability were assessed. During six months, 17 residents underwent training with the 6-TSM or the 3-TTM as allocated. The mean duration of training with 6-TSM and 3-TTM was similar (7.8 vs 8.1 h). The criterion-related validity of the 6-TSM was shown by significantly increased skill improvement in the 6-TSM residents, as compared with the 3-TTM residents at MIST-VR. Construct validity the of 6-TSM was shown by the finding that the experts' baseline was superior to the residents' baseline. The responsiveness of the 6-TSM was shown by the significantly increased skill improvement of the 6-TSM residents in sliding knot, leak, and operating time. The test-retest reliability of the 6-TSM was good (> 0.80), except for accuracy error and dangerous movements (Cronbach's intraclass correlation coefficient alpha: 0.57, p < 0.0001; 0.62, p < 0.0001, respectively). The interrater reliability of the 6-TSM was good (>0.80) except for leak (Kendall's concordance coefficient tau_b:0.76, p = 0.06 for hand-sewn anastomosis) and dangerous movements (tau_b:0.72, p = 0.08 for suturing perforation and tau_b:0.68, p = 0.10 for hand-sewn anastomosis). The perresident cost for 6-TSM was 769 dollars. The 6-TSM is a valid and reliable learning tool for surgical residents' acquisition of laparoscopic motor skills.

Visuospatial skills and computer game experience influence the performance of virtual endoscopy

Advanced medical simulators have been introduced to facilitate surgical and endoscopic training and thereby improve patient safety. Residents trained in the Procedicus Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) laparoscopic simulator perform laparoscopic cholecystectomy safer and faster than a control group. Little has been reported regarding whether factors like gender, computer experience, and visuospatial tests can predict the performance with a medical simulator. Our aim was to investigate whether such factors influence the performance of simulated gastroscopy. Seventeen medical students were asked about computer gaming experiences. Before virtual endoscopy, they performed the visuospatial test PicCOr, which discriminates the ability of the tested person to create a three-dimensional image from a two-dimensional presentation. Each student performed one gastroscopy (level 1, case 1) in the GI Mentor II, Simbionix, and several variables related to performance were registered. Percentage of time spent with a clear view in the endoscope correlated well with the performance on the PicSOr test (r = 0.56, P < 0.001). Efficiency of screening also correlated with PicSOr (r = 0.23, P < 0.05). In students with computer gaming experience, the efficiency of screening increased (33.6% +/- 3.1% versus 22.6% +/- 2.8%, P < 0.05) and the duration of the examination decreased by 1.5 minutes (P < 0.05). A similar trend was seen in men compared with women. The visuospatial test PicSOr predicts the results with the endoscopic simulator GI Mentor II. Two-dimensional image experience, as in computer games, also seems to affect the outcome.

Randomized clinical trial of virtual reality simulation for laparoscopic skills training

This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.

Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy.

The impact of gender and hand dominance on operative performance may be a subject of prejudice among surgeons, reportedly leading to discrimination and lack of professional promotion. However, very little objective evidence is available yet on the matter. This study was conducted to identify factors that influence surgeons' performance, as measured by a virtual reality computer simulator for laparoscopic surgery. This study included 25 surgical residents who had limited experience with laparoscopic surgery, having performed fewer than 10 laparoscopic cholecystectomies. The participants were registered according to their gender, hand dominance, and experience with computer games. All of the participants performed 10 repetitions of the six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) within 1 month. Assessment of laparoscopic skills was based on three parameters measured by the simulator: time, errors, and economy of hand movement. Differences in performance existed between the compared groups. Men completed the tasks in less time than women ( p = 0.01, Mann-Whitney test), but there was no statistical difference between the genders in the number of errors and unnecessary movements. Individuals with right hand dominance performed fewer unnecessary movements ( p = 0.045, Mann-Whitney test), and there was a trend toward better results in terms of time and errors among the residence with right hand dominance than among those with left dominance. Users of computer games made fewer errors than nonusers ( p = 0.035, Mann-Whitney test). The study provides objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience. These results may influence the future development of training program for laparoscopic surgery. They also pose a challenge to individuals responsible for the selection and training of the residents.

Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills

Background The study was carried out to analyze the learning rate for laparoscopic skills on a virtual reality training system and to establish whether the simulator was able to differentiate between surgeons with different laparoscopic experience. Methods Forty-one surgeons were divided into three groups according to their experience in laparoscopic surgery: masters (group 1, performed more than 100 cholecystectomies), intermediates (group 2, between 15 and 80 cholecystectomies), and beginners (group 3, fewer than 10 cholecystectomies) were included in the study. The participants were tested on the Minimally Invasive Surgical Trainer–Virtual Reality (MIST-VR) 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator. Results The learning curves regarding time reached plateau after the second repetition for group 1, the fifth repetition for group 2, and the seventh repetition for group 3 (Friedman’s tests P <0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman’s tests, P >0.2) indicating the absence of a learning curve for these parameters. Group 2 error scores reached plateau after the first repetition, and group 3 after the fifth repetition. Group 2 improved their economy of movement score up to the third repetition and group 3 up to the sixth repetition (Friedman’s tests, P <0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P <0.05). Conclusions Different learning curves existed for surgeons with different laparoscopic background. The familiarization rate on the simulator was proportional to the operative experience of the surgeons. Experienced surgeons demonstrated best laparoscopic performance on the simulator, followed by those with intermediate experience and the beginners. These differences indicate that the scoring system of MIST-VR is sensitive and specific to measuring skills relevant for laparoscopic surgery.