Assessing the learning curve for the acquisition of laparoscopic skills on a virtual reality simulator (original) (raw)
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The American Journal of Surgery, 2003
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 Ͻ0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman's tests, P Ͼ0.2) 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 Ͻ0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P Ͻ0.05). 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.
The Journal of Urology, 2009
To ensure patient safety and surgical efficiency, much emphasis has been placed on the training of laparoscopic skills using virtual reality simulators. The purpose of this study was to determine whether laparoscopic skills can be objectively quantified by measuring specific skill parameters during training in a virtual reality surgical simulator (VRSS). Materials and Methods: Ten medical students (with no laparoscopic experience) and ten urology residents (PGY3-5 with limited laparoscopic experience) were recruited to participate in a ten-week training course in basic laparoscopic skills (camera, cutting, peg transfer and clipping skills) on a VRSS. Data were collected from the training sessions. The time that individuals took to complete each task and the errors that they made were analyzed independently. Results: The mean time that individuals took to complete tasks was significantly different between the groups (p < 0.05), with the residents being faster than the medical students. The residents' group also completed the tasks with fewer errors. The majority of the subjects in both groups exhibited a significant improvement in their task completion time and error rate. Conclusion: The findings in this study demonstrate that laparoscopic skills can be objectively measured in a VRSS based on quantified skill parameters, including the time spent to complete skill tasks and the associated error rate. We conclude that a VRSS is a feasible tool for training and assessing basic laparoscopic skills.
Surgical Endoscopy, 2007
Background: The recent focus on quality of care and patient safety has been accompanied by increased interest in standardizing the training for laparoscopic surgeons. Studies have shown that laparoscopic simulators can be used to train surgical skills. Therefore, we designed an experiment to compare the effectiveness of two popular training systems. One system was based on a physical model, whereas the other used a virtual reality model. Methods: A total of 32 medical students and residents were tested on both simulators. Time required for task completion and number of errors committed were recorded and compared. Results: The physical training system differentiated among experience levels on three of the five tasks when time was used as a measure and four of five tasks when score was used, whereas the virtual reality system yielded statistically significant results in eight of 13 tasks for time and in five of 13 tasks for score. Conclusion: The physical model is more sensitive than the virtual reality one in detecting differences in levels of laparoscopic surgical experience.
Journal of Surgical Education, 2007
BACKGROUND: Virtual reality simulators are a component of the armamentarium for training surgical residents. No one knows exactly how to incorporate virtual reality simulators into a curriculum. The purpose of this study was to document and show the learning curve and test-retest reliability of 2 tasks on a virtual reality-training simulator (LapSim; Surgical Science, Göteborg, Sweden) in laparoscopic surgery. METHODS: Twenty-nine medical students participated in 8 iterations of 7 virtual reality tasks ("camera navigation" (CN), "instrument navigation," "coordination," "grasping," "lifting and grasping" (LG), "cutting," and "clip applying") Learning curves for each outcome variable of the CN and LG tasks were generated. Using ANOVA, we evaluated the differences between each score from attempt number 7 to attempt number 8 to document test-retest reliability. RESULTS: A plateau in the learning curve occurred within 8 sessions for CN misses, CN tissue damage, CN maximum damage, and LG maximum damage. Over the course of 8 sessions, a plateau in the learning curve was nearly reached for CN time, CN drift, CN path, CN angular path, and LG left and right path. The following variables had a downward trend to the mean learning curve over 8 sessions, but they did not reach a plateau: LG time, LG left and right miss, LG left and right angular path, and LG tissue damage. CONCLUSION: Using the LapSim virtual reality simulator, we documented a learning curve and test-retest reliability for each outcome variable for CN and LG for rank novices. The modeling of the general learning curve is useful in designing training program. These results may be important in developing standards for technical evaluation in a surgical training curriculum. (
Novices outperform experienced laparoscopists on virtual reality laparoscopy simulator
JSLS: Journal of the …, 2008
Background and Objectives:Virtual reality has been poorly studied among gynecologic surgeons. The aim of this study was to evaluate whether performance on the Minimally Invasive Surgery Trainer-Virtual Reality (MISTVR) laparoscopic trainer reflects laparoscopic experience among gynecologic surgeons and trainees.Methods:Twenty-six medical students, residents, and attending gynecologic surgeons completed a MIST-VR training program. A new simulated task was then presented to each participant, who repeated the task until proficiency was reached.Results:Attending physicians performed poorly when compared with medical students, requiring more than twice the number of attempts to reach proficiency (Mann-Whitney P<0.01). Among medical students and residents, there was an association between years of live laparoscopy experience and poor simulator performance (Spearman r P=0.01).Conclusion:Increased operating room experience and age were associated with worsening simulator performance. Several potential explanations for this trend are discussed, including lack of tactile and contextual feedback. Caution should be exercised when considering current virtual reality simulator technology as a measure of experience or ability among gynecologic surgeons.
Evaluation of Laparoscopy Virtual Reality Training on the Improvement of Trainees’ Surgical Skills
Medicina
Background and objectives: The primary objective was to evaluate the benefit of training with virtual reality simulation. The secondary objective was to describe the short-term skill acquisition obtained by simulation training and to determine the factors affecting its magnitude. Materials and Methods: We prospectively performed a three-stage evaluation: face, constructive, and predictive to evaluate the training with a laparoscopic simulator with haptic feedback. The participants (n = 63) were divided according to their level of experience into three groups: 16% residents; 46% specialists and 38% were consultants. Results: Face evaluation demonstrates the acceptance of the design and realism of the tasks; it showed a median score of eight (IQR 3) on a Likert scale and 54% of participants (n = 34) gave the tissue feedback a moderate rating. Constructive evaluation demonstrates the improvement of the participants in the training session and the ability of the designed task to disting...
2011
Virtual Reality 350 caused by indirect manipulation and visualization of the patient. They have to acquire new cognitive and motor skills, and they have to accommodate to the reduced workspace and to visualizing the intervention through a 2D monitor. Due to these limitations, acquisition of MIS skills requires a long learning curve. Moreover, there is also a crescent pressure for safer, transparent and reproducible training programs. They should also allow for practice anywhere at any time, and make use of structured and objective training curricula to determine accurately the trainee´s preparation.
Effect of virtual reality training on laparoscopic surgery: randomised controlled trial
BMJ: British Medical …, 2009
Objective To assess the effect of virtual reality training on an actual laparoscopic operation.Design Prospective randomised controlled and blinded trial.Setting Seven gynaecological departments in the Zeeland region of Denmark.Participants 24 first and second year registrars specialising in gynaecology and obstetrics.Interventions Proficiency based virtual reality simulator training in laparoscopic salpingectomy and standard clinical education (controls).Main outcome measure The main outcome measure was technical performance assessed by two independent observers blinded to trainee and training status using a previously validated general and task specific rating scale. The secondary outcome measure was operation time in minutes.Results The simulator trained group (n=11) reached a median total score of 33 points (interquartile range 32-36 points), equivalent to the experience gained after 20-50 laparoscopic procedures, whereas the control group (n=10) reached a median total score of 23 (22-27) points, equivalent to the experience gained from fewer than five procedures (P<0.001). The median total operation time in the simulator trained group was 12 minutes (interquartile range 10-14 minutes) and in the control group was 24 (20-29) minutes (P<0.001). The observers’ inter-rater agreement was 0.79.Conclusion Skills in laparoscopic surgery can be increased in a clinically relevant manner using proficiency based virtual reality simulator training. The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved. Simulator training should be considered before trainees carry out laparoscopic procedures.Trial registration ClinicalTrials.gov NCT00311792.