Reality Laparoscopic Simulator Research Articles

Needs analysis for the development of a virtual reality laparoscopic hiatal hernia repair simulator

Needs analysis for the development of a virtual reality laparoscopic hiatal hernia repair simulator

283 The Impact of Augmented Reality Laparoscopic Simulator in Improving Performance Metrics in General Surgical Trainees

Abstract Aim To assess the impact of simulated laparoscopic trainers on improving surgical trainees’ technical ability in completing a laparoscopic appendicectomy by measuring effect on completion time and distance travelled with standard instruments. Method Six CT1 (early-stage) trainees with little prior operative exposure were selected from the North-West of England Deanery to perform x10 appendicectomy simulated exercises with the Augmented Reality Laparoscopic Simulator (LapAR™), interspersed by x3 Lapass exercises. Metrics including ‘Time of completion’ and ‘Distance travelled’ were collected by the simulators and analysed. Results Repeated laparoscopic appendicectomies with the LapAR™ improved performance time for 100% of trainees, with an average of 55% (Regression coefficient -0.65) and improved distance travelled for 75% of the trainees with an average improvement of 39% (Coefficient -2.67). Improvement in instrument smoothness, acceleration and ambidexterity were also observed. Conclusions LapAR™ use has improved all performance metrics for most surgical trainees and proves to be an invaluable tool for surgical training.

Training on a virtual reality laparoscopic simulator improves performance of live laparoscopic surgery.

IntroductionTo determine whether training laparoscopic nephrectomy (LN) with a virtual reality (VR) simulator improves the performance of porcine LN.MethodsTwelve urological residents were assigned to two groups: a training and a non‐training group. All participants performed baseline assessments of LN skills and time on the LapPASS® simulator. The training group received preoperative LapPASS® training. Both groups then performed LN using a porcine model. The operations were videotaped and evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) system. After porcine LN, the training group performed a final LN with the LapPASS® simulator.ResultsThere was no significant difference in the operation time required for porcine LN. There were no significant differences in the total A (autonomy), B (bimanual dexterity), D (depth perception), or T (tissue handling) GOALS scores. However, the total E (efficiency) score in the training group was higher than that in the non‐training group (P = .030). The final LN score with LapPASS® was significantly higher than the baseline (P = .004).ConclusionsThe results of this study demonstrated that VR LN training improved performance in an actual operation. VR‐based procedural simulation could become a vital part of the laparoscopic training program for residents.

Virtual reality laparoscopic simulator

Background: Virtual reality laparoscopic simulators were introduced to provide an optimal and safe learning environment for surgical trainees. The simulators had been validated and proven to be beneficial. Materials and Methods: The aim of this study is to assess the performance of the local surgical trainees using a validated simulator and help in the development of a training program using the simulator. Prospective repeated measures study in a single center using a validated virtual reality simulator was performed. Years 1 and 2 local postgraduate surgical trainees with limited laparoscopic cholecystectomy experience were included in the study. The trainees underwent a proposed training module, and the simulator evaluated each performance. Comparison was made between the performance before and after the training module. Results: Nine surgical trainees (eight males, median age: 33 years old) with a median of 5 years of surgical experience after graduation were included in the study. The time to complete each basic laparoscopic skill improved between 26.5% and 64.3% (P Conclusion: Virtual reality laparoscopic training should be implemented as part of training as it improves certain skill sets.

Higher quality camera navigation improves the surgeon's performance: Evidence from a pre-clinical study.

Introduction:To objectively assess the quality of laparoscopic camera navigation (LCN), the structured assessment of LCN skills (SALAS) score was developed and validated for laparoscopic cholecystectomy. The aim of this pre-clinical study was to investigate the influence of LCN on surgical performance during virtual cholecystectomy (vCHE) using this score.Methods:A total of 84 medical students were included in this prospective study. Individual characteristics were assessed with questionnaires. Participants completed a structured 2-day training course on a validated virtual reality laparoscopic simulator. At the end of the course, all students took over LCN during vCHE, all performed by the same surgeon. The numbers of errors regarding centering, horizon adjustment and instrument visualisation as well as manual and verbal corrections by the surgeon were recorded to calculate the SALAS score (range 5–25) to investigate the influence of LCN on surgical performance. The study population was divided by the recorded SALAS score into low and medium performers (Group A; 1st–3rd quartile; n = 60) and high performers (Group B, 4th quartile, n = 21).Results:The SALAS score of the camera assistant correlates positively with the surgeon's overall performance in vCHE (P < 0.001), and the surgeon's virtual laparoscopic performance was significantly better in Group B (P < 0.001). Moreover, a significantly shorter operation time during vCHE was shown for Group B (Median (IQR); Group A: 508 s [429 s; 601 s]; Group B: 422 s [365 s; 493 s]; P = 0.001). Frequent gaming and a higher self-confidence to assist during a basic laparoscopic procedure were associated with a higher SALAS score (P = 0.013).Conclusion:In this pre-clinical setting, the surgeon's virtual performance is significantly influenced by the LCN quality. LCN by high performers resulted in a shorter operation time and a lower error rate.

Management of Bleeding Complications in Virtual Reality Laparoscopy

The aim of this study was to compare the impact of induced bleeding complication training with regular training on a virtual reality laparoscopic (VRL) simulator. Although bleeding complications occur rarely during laparoscopic surgery, they usually arise without warning and may have severe consequences for the patient because complication management training is not currently widespread. Third-year medical students (n = 41) were randomly selected for 2 curricular courses on how to perform a bimanual task on a VRL simulator. Both the regular training group (RTG) and the induced bleeding complication training (ICT) group performed 2 regular training sessions and 9 training sessions. For the ICT group the training sessions were with a bleeding complication. The 2 groups were comparable regarding their initial performance levels and improved significantly in task time and handling economics throughout the course (P &amp;lt; 0.001). When a bleeding complication occurred during the initial phase, performance parameters were significantly worse (P &amp;lt; 0.05). During a bleeding complication, the ICT group showed a significant improvement in time, handling economics, and blood loss (P &amp;lt; 0.001) throughout the training course, whereas the RTG group showed no improvement. Induced complication training has a positive influence on the management of bleeding on the VRL simulator. Structured laparoscopic complication management training should be implemented during surgical education as an add-on to regular procedural training.

Subjective and Objective Quantification of the Effect of Distraction on Physician's Workload and Performance During Simulated Laparoscopic Surgery.

BackgroundDistracting interference cognitive tasks place undeniable pressure on the minds of people who need high precision and attention during the tasks, such as those tasks performed during surgery; these tasks might affect current surgical procedures. We measured the effect of additional cognitive tasks on the mental load of the physician by measuring the mean change in pupil size, blink rate, and subjective assessment during surgery.Material/MethodsWe recruited 24 participants with different levels of laparoscopic surgery to perform a complete appendectomy using a standardized virtual reality laparoscopic surgery simulator. The participants then performed the cognitive task (arithmetic problem), after that they performed an appendectomy surgery task while completing the cognitive task on the simulator. All participants wore trackers to monitor pupil size and blink rate during surgery and the cognitive task. The National Aeronautics and Space Administration (NASA) Task Load Index (TLX) score also recorded performance parameters during the surgical mission.ResultsThe double-task pupil size and the blink rate were significantly increased compared to the single-task observation, and the associated increase in psychological load might have been affected by surgical performance, and the performance parameters were also statistically significant. However, for the aforementioned parameters, experienced surgeons had some differences compared with inexperienced surgeons, but these differences did not reach statistical significance.ConclusionsDistracted cognitive task stimulation in the operating room can increase the surgeon’s psychological burden while also affecting their operational skills, thereby threatening patient safety; reduced cognitive costs might be obtained by improving or managing cognitive deficits.

Validation of a virtual reality laparoscopic appendicectomy simulator: a novel process using cognitive task analysis.

Virtual reality (VR) simulation is a vital component of surgical training with demonstrated improvements in surgical quality and clinical outcome. To validate the LAP Mentor (Simbionix™) laparoscopic appendicectomy (LA) VR simulator with inclusion of a novel tool, Cognitive Task Analysis (CTA). Thirty-two novices and nine experienced surgeons performed two simulated LAs. An expert-consensus questionnaire guided face validity assessment. Content validity was assessed using CTA-derived questions encompassing eight operative steps and four decision points. Construct validity was evaluated using dexterity metrics, masked assessment of surgical quality using the OSATS global rating scale, and mental workload from two validated tools: the NASA-TLX and SMEQ. Ten novices performed eight further LAs for learning curve assessment. Face validity was demonstrated across all domains. Considering content validity, the essential technical and non-technical steps were evident. The experienced group performed the procedure quicker (median time 361 vs. 538s, P= 0.0039) with fewer total movements (426 vs. 641, P< 0.0001) and shorter idle time (131 vs. 199s, P= 0.0006). This correlated with higher OSATS scores (median 33.5 vs. 22.2, P< 0.0001) and lower mental demand (NASA-TLX: 9.0 vs. 13.75, P= 0.012; SMEQ: 60 vs. 80, P= 0.0025), indicating construct validity. Learning curve data showed statistically significant improvements after the 7th session for procedure time, total movements and idle time, which correlated with reduction in mental demand. The LAP Mentor demonstrates face, content and construct validity for LA; thus, it can be used as an effective tool in surgical training. Task repetition leads to achievement of expert benchmarks.

Development of an objective assessment tool for total laparoscopic hysterectomy: A Delphi method among experts and evaluation on a virtual reality simulator.

IntroductionTotal Laparoscopic hysterectomy (LH) requires an advanced level of operative skills and training. The aim of this study was to develop an objective scale specific for the assessment of technical skills for LH (H-OSATS) and to demonstrate feasibility of use and validity in a virtual reality setting.Material and methodsThe scale was developed using a hierarchical task analysis and a panel of international experts. A Delphi method obtained consensus among experts on relevant steps that should be included into the H-OSATS scale for assessment of operative performances. Feasibility of use and validity of the scale were evaluated by reviewing video recordings of LH performed on a virtual reality laparoscopic simulator. Three groups of operators of different levels of experience were assessed in a Marseille teaching hospital (10 novices, 8 intermediates and 8 experienced surgeons). Correlations with scores obtained using a recognised generic global rating tool (OSATS) were calculated.ResultsA total of 76 discrete steps were identified by the hierarchical task analysis. 14 experts completed the two rounds of the Delphi questionnaire. 64 steps reached consensus and were integrated in the scale. During the validation process, median time to rate each video recording was 25 minutes. There was a significant difference between the novice, intermediate and experienced group for total H-OSATS scores (133, 155.9 and 178.25 respectively; p = 0.002). H-OSATS scale demonstrated high inter-rater reliability (intraclass correlation coefficient [ICC] = 0.930; p<0.001) and test retest reliability (ICC = 0.877; p<0.001). High correlations were found between total H-OSATS scores and OSATS scores (rho = 0.928; p<0.001).ConclusionThe H-OSATS scale displayed evidence of validity for assessment of technical performances for LH performed on a virtual reality simulator. The implementation of this scale is expected to facilitate deliberate practice. Next steps should focus on evaluating the validity of the scale in the operating room.

Predictors of laparoscopic simulation performance among practicing obstetrician gynecologists

While simulation training has been established as an effective method for improving laparoscopic surgical performance in surgical residents, few studies have focused on its use for attending surgeons, particularly in obstetrics and gynecology. Surgical simulation may have a role in improving and maintaining proficiency in the operating room for practicing obstetrician gynecologists. We sought to determine if parameters of performance for validated laparoscopic virtual simulation tasks correlate with surgical volume and characteristics of practicing obstetricians and gynecologists. All gynecologists with laparoscopic privileges (n=347) from 5 academic medical centers in New York City were required to complete a laparoscopic surgery simulation assessment. The physicians took a presimulation survey gathering physician self-reported characteristics and then performed 3 basic skills tasks (enforced peg transfer, lifting/grasping, and cutting) on the LapSim virtual reality laparoscopic simulator (Surgical Science Ltd, Gothenburg, Sweden). The association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category) were examined with regression models. The average number of laparoscopic procedures per month was a significant predictor of total time on all 3 tasks (P= .001 for peg transfer; P= .041 for lifting and grasping; P < .001 for cutting). Average monthly laparoscopic surgical volume was a significant predictor of 2 efficiency scores in peg transfer, and all 4 efficiency scores in cutting (P=.001 to P= .015). Surgical volume was a significant predictor of errors in lifting/grasping and cutting (P < .001 for both). Self-rated laparoscopic skill level was a significant predictor of total time in all 3 tasks (P < .0001 for peg transfer; P= .009 for lifting and grasping; P<.001 for cutting) and a significant predictor of nearly all efficiency scores and errors scores in all 3 tasks. In addition to total time, there was at least 1 other objective performance measure that significantly correlated with surgical volume for each of the 3 tasks. Higher-volume physicians and those with fellowship training were more confident in their laparoscopic skills. By determining simulation performance as it correlates to active physician practice, further studies may help assess skill and individualize training to maintain skill levels as case volumes fluctuate.

Laparoscopic assistance by operating room nurses: Results of a virtual-reality study

BackgroundLaparoscopic assistance is often entrusted to a less experienced resident, medical student, or operating room nurse. Data regarding laparoscopic training for operating room nurses are not available. ObjectivesThe aim of the study was to analyse the initial performance level and learning curves of operating room nurses in basic laparoscopic surgery compared with medical students and surgical residents to determine their ability to assist with this type of procedure. DesignThe study was designed to compare the initial virtual reality performance level and learning curves of user groups to analyse competence in laparoscopic assistance. ParticipantsThe study subjects were operating room nurses, medical students, and first year residents. MethodsParticipants performed three validated tasks (camera navigation, peg transfer, fine dissection) on a virtual reality laparoscopic simulator three times in 3 consecutive days. Laparoscopic experts were enrolled as a control group. Participants filled out questionnaires before and after the course. ResultsNurses and students were comparable in their initial performance (p>0.05). Residents performed better in camera navigation than students and nurses and reached the expert level for this task. Residents, students, and nurses had comparable bimanual skills throughout the study; while, experts performed significantly better in bimanual manoeuvres at all times (p<0.05). ConclusionThe included user groups had comparable skills for bimanual tasks. Residents with limited experience reached the expert level in camera navigation. With training, nurses, students, and first year residents are equally capable of assisting in basic laparoscopic procedures.

Objective Evaluation of the Effects of Deployment on Laparoscopic Skills: The Simulation and Deployment Laparoscopic Skills Study.

To assess the effects of deployment on basic laparoscopic skills of general surgeons and obstetrics/gynecology (OB/GYN) physicians. This was a prospective 10-site study. Active duty Army OB/GYN and general surgery physicians scheduled to deploy were invited to participate. Before deployment, they performed fundamentals of laparoscopic surgery (FLS) tasks and specialty-specific procedures on a virtual reality laparoscopic simulator. Upon returning, physicians repeated the same evaluations. Questions about perceived comfort with laparoscopic procedures were asked before and after deployment. Statistical analysis included paired t tests for continuous variables and nonparametric for ordinal data with a p value of <0.05 considered significant. 121 deploying providers were invited to participate; 35 agreed and 29 completed the predeployment skills assessment. After deployment, 15 providers had postassessment evaluation data collected, and their results were used for analysis. Though physicians reported a decrease in their perception of preparedness for advanced laparoscopic procedures and complications, there was no decrement in their performance of FLS tasks or the basic laparoscopic procedures. Time away from regular clinical practice during deployments did not significantly affect surgeons' performance as measured by a virtual reality laparoscopic simulator. Additional study on effects on advanced procedures should be considered.

A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents' simulation curriculum.

The objective of this study was to assess the effect of a serious game skills competition on voluntary usage of a laparoscopic simulator among first-year surgical residents' standard simulation curriculum. With research ethics board approval, informed consent was obtained from first-year surgical residents enrolled in an introductory surgical simulation curriculum. The class of 2013 served as a control cohort following the standard curriculum which mandates completion of six laparoscopic simulator skill tasks. For the 2014 competition cohort, the only change introduced was the biweekly and monthly posting of a leader board of the top three and ten fastest peg transfer times. Entry surveys were administered assessing attitudes towards simulation-based training and competition. Cohorts were observed for 5months. There were 24 and 25 residents in the control and competition cohorts, respectively. The competition cohort overwhelmingly (76%) stated that they were not motivated to deliberate practice by competition. Median total simulator usage time was 132min (IQR=214) in the competition cohort compared to 89 (IQR=170) in the control cohort. The competition cohort completed their course requirements significantly earlier than the control cohort (χ 2=6.5, p=0.01). There was a significantly greater proportion of residents continuing to use the simulator voluntarily after completing their course requirements in the competition cohort (44 vs. 4%; p=0.002). Residents in the competition cohort were significantly faster at peg transfer (194±66 vs. 233±53s, 95% CI of difference=4-74s; p=0.03) and significantly decreased their completion time by 33±54s (95% CI 10-56s; paired t test, p=0.007). A simple serious games skills competition increased voluntary usage and performance on a laparoscopic simulator, despite a majority of participants reporting they were not motivated by competition. Future directions should endeavour to examine other serious gaming modalities to further engage trainees in simulated skills development.

Efficacy of short-term training for acquisition of basic laparoscopic skills

Abstract Objective To determine whether our newly developed short-term training program contributes to the acquisition of basic laparoscopic surgery skills. Design Prospective study (Canadian Task Force Class II). Setting University Hospital. Participants Four obstetrics-gynecology residents who participated in our 2-month laparoscopic training course. Interventions Virtual reality laparoscopic surgery simulator-based assessment of four basic tasks: (1) “camera manipulation”; (2) “eye-hand coordination”; (3) “two-handed maneuvers”; and (4) “cutting,” before and after the course. Measurements and main results Mean times required to perform the tasks before and after training were compared. The mean times required to perform three of the four tasks (except camera manipulation) were significantly reduced after training. Total instrument path lengths were reduced, especially for instruments used by the dominant hand. Conclusion Use of the virtual reality laparoscopic surgery simulator allowed us to objectively assess residents' acquisition of basic laparoscopic skills. We found that residents more readily acquired dominant-hand skills during their 2-month training. We conclude that our training system serves as an effective initial step towards the acquisition of the necessary laparoscopic surgery skills, even though residents do not actually perform surgeries during the training period.

Transfer of skills on LapSim virtual reality laparoscopic simulator into the operating room in urology.

Objective:Assessing the predictive validity of the LapSim simulator within a urology residency program.Materials and Methods:Twelve urology residents at McGill University were enrolled in the study between June 2008 and December 2011. The residents had weekly training on the LapSim that consisted of 3 tasks (cutting, clip-applying, and lifting and grasping). They underwent monthly assessment of their LapSim performance using total time, tissue damage and path length among other parameters as surrogates for their economy of movement and respect for tissue. The last residents’ LapSim performance was compared with their first performance of radical nephrectomy on anesthetized porcine models in their 4th year of training. Two independent urologic surgeons rated the resident performance on the porcine models, and kappa test with standardized weight function was used to assess for inter-observer bias. Nonparametric spearman correlation test was used to compare each rater's cumulative score with the cumulative score obtained on the porcine models in order to test the predictive validity of the LapSim simulator.Results:The kappa results demonstrated acceptable agreement between the two observers among all domains of the rating scale of performance except for confidence of movement and efficiency. In addition, poor predictive validity of the LapSim simulator was demonstrated.Conclusions:Predictive validity was not demonstrated for the LapSim simulator in the context of a urology residency training program.

Virtual reality versus box laparoscopic simulators in trainee selection and aptitude testing.

The purpose of this study was to compare the validity of high-fidelity and low-fidelity simulators in a selection center environment, using measures of construct and concurrent validity. A total of 46 novice and expert participants were tested on both the low-fidelity Fundamentals of Laparoscopic Surgery (FLS) box trainer and the high fidelity, Lapsim, virtual reality laparoscopic simulator. Outcome scores and performance metrics where recorded. Experts performed better than novices on the FLS (median 71% vs. 51%; P<0.0001) but not the Lapsim (59.1% vs. 57.1%; P = 0.41). No correlation was found between overall Lapsim metrics and FLS outcome scores (correlation = -0.024; P = 0.874). Although most novice participants performed within a narrow window on the FLS simulator, a few high-performing and low-performing outliers where identified. In a selection center scenario, testing with low-fidelity platforms appears to demonstrate greater validity. Outliers can be identified using low-fidelity simulators.

Effect of Computer Game Playing on Baseline Laparoscopic Simulator Skills

Studies examining the possible association between computer game playing and laparoscopic performance in general have yielded conflicting results and neither has a relationship between computer game playing and baseline performance on laparoscopic simulators been established. The aim of this study was to examine the possible association between previous and present computer game playing and baseline performance on a virtual reality laparoscopic performance in a sample of potential future medical students. The participating students completed a questionnaire covering the weekly amount and type of computer game playing activity during the previous year and 3 years ago. They then performed 2 repetitions of 2 tasks ("gallbladder dissection" and "traverse tube") on a virtual reality laparoscopic simulator. Performance on the simulator were then analyzed for association to their computer game experience. Local high school, Norway. Forty-eight students from 2 high school classes volunteered to participate in the study. No association between prior and present computer game playing and baseline performance was found. The results were similar both for prior and present action game playing and prior and present computer game playing in general. Our results indicate that prior and present computer game playing may not affect baseline performance in a virtual reality simulator.

Improved nondominant hand performance on a laparoscopic virtual reality simulator after playing the Nintendo Wii

Video games have been shown to improve eye-hand coordination, spatial visualization, manual dexterity, and rapid mental processing, which are important in the acquisition of laparoscopic skills. This study investigated the relationship between playing Nintendo(®) Wii™ and virtual reality (VR) laparoscopic surgery simulator performance. We hypothesized that playing the Wii would improve surgical skills performance on a VR laparoscopic simulator and hoped to elucidate which tasks, in particular, would be most beneficial for nondominant hand training. This was a single-blinded, randomized, prospective study conducted with 23 student volunteers. VR laparoscopic skills were assessed at baseline on a Simbionix LapMentor™ Surgical Simulator (Simbionix Ltd., Israel) and after the gaming period of 2 weeks. Simulator performance metrics were compared between groups using nonparametric statistics and an alpha of 0.05. Compared with the control group, the Wii-playing group demonstrated greater improvement of six measures, including accuracy on the eye-hand coordination task (p = 0.04), faster completion time (p = 0.04), decreased number of left-handed movements (p = 0.03), decreased left handed total path length (p = 0.03), decreased total number of grasping attempts (p = 0.04), and improved left-handed economy of movement (p = 0.05) for the bimanual clipping and grasping task. When comparing the number of measures improved upon by the Wii-playing group and the control group for all three tasks, the Wii-playing group consistently outperformed the control group in 18 measures compared with the control group's improvement in 6. This study further characterizes the association between video game playing and surgical performance. Improvements following the intervention were made in the most basic of surgical skills, most notably with the nondominant hand, suggesting that short-term playing of the Wii could improve bimanual dexterity and expedite the acquisition of basic surgical skills.

Psychomotor skills and cognitive load training on a virtual reality laparoscopic simulator for tubal surgery is effective

ObjectivesValidation of a virtual reality (VR) simulator for the training and assessment of laparoscopic tubal surgery and mapping of cognitive load. Study designProspective cohort study conducted at the Imperial College Virtual Reality Surgical Skills laboratory amongst 25 trainees and nine senior gynaecologists. Participants performed two sessions of salpingectomy and salpingotomy procedures on a VR simulator to assess construct validity. Nine novices performed ten such sessions to enable assessment of the learning curve. The relationship between cognitive load and the dexterity parameters was assessed. Simulator fidelity was reported by experienced and intermediate level gynaecologists. Statistical analyses utilised non-parametric tests, Kruskall–Wallis and Mann–Whitney U tests. Learning curves were assessed using the Friedman test and Wilcoxon Signed Ranks test. Relationship between dexterity metrics and cognitive load was performed using Spearman's rank order correlation. ResultsSalpingectomy demonstrated construct validity for time taken by experienced, intermediate and novice gynaecologists (median 170 vs. 191 vs. 313s (P=0.003) respectively) and movements (median 200 vs. 267 vs. 376s, P=0.045). Salpingotomy demonstrated construct validity for time taken (median 183 vs. 191 vs. 306s, P=<0.001) and movements (median 210 vs. 233 vs. 328s, P=0.005). Learning curve analysis for salpingectomy displayed a plateau for time taken after the eighth session, and the fourth session for movements. Salpingotomy displayed a plateau after the eighth session for both time taken and movements. Cognitive load correlated significantly with dexterity parameters. The fidelity scores were not significantly different between the two procedures (P=0.619). ConclusionThe LAP Mentor VR laparoscopic simulator is a valid and effective tool for training novice surgeons in ectopic pregnancy surgery. Reduction in cognitive load significantly correlates with the learning curves.

Does Innate Motor Skill Predict Medical Student's Interest in Pursuing a Surgical Specialty?

To determine, prospectively the relationship between medical students' motor skills determined on a virtual reality laparoscopic simulator and their level of interest in pursuing a surgical specialty after graduation.