Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies.

BACKGROUND Virtual reality (VR) training has been shown previously to improve intraoperative performance during part of a laparoscopic cholecystectomy. The aim of this study was to assess the effect of proficiency-based VR training on the outcome of the first 10 entire cholecystectomies performed by novices. METHODS Thirteen laparoscopically inexperienced residents were randomized to either (1) VR training until a predefined expert level of performance was reached, or (2) the control group. Videotapes of each resident's first 10 procedures were reviewed independently in a blinded fashion and scored for predefined errors. RESULTS The VR-trained group consistently made significantly fewer errors (P = .0037). On the other hand, residents in the control group made, on average, 3 times as many errors and used 58% longer surgical time. CONCLUSIONS The results of this study show that training on the VR simulator to a level of proficiency significantly improves intraoperative performance during a resident's first 10 laparoscopic cholecystectomies.

[1]  H. Lönroth,et al.  The transfer of basic skills learned in a laparoscopic simulator to the operating room , 2002, Surgical Endoscopy And Other Interventional Techniques.

[2]  B Cagir,et al.  The learning curve for laparoscopic cholecystectomy. , 1994, Journal of laparoendoscopic surgery.

[3]  Mike Hansell,et al.  Measuring Behaviour: An Introductory Guide, Paul Martin, Patrick Bateson. University of Cambridge Press, Cambridge (1986), x, +200. Price £20.00 (hardback), £6.95 (paperback) , 1987 .

[4]  A. Cuschieri,et al.  What do master surgeons think of surgical competence and revalidation? , 2001, American journal of surgery.

[5]  Gunnar Ahlberg,et al.  Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil? , 2005, American journal of surgery.

[6]  Sir Ara W Darzi,et al.  The impact of minimally invasive surgical techniques. , 2004, Annual review of medicine.

[7]  R. Satava,et al.  Virtual Reality Simulation for the Operating Room: Proficiency-Based Training as a Paradigm Shift in Surgical Skills Training , 2005, Annals of surgery.

[8]  P. Maurette.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[9]  T. Grantcharov,et al.  Randomized clinical trial of virtual reality simulation for laparoscopic skills training , 2004, The British journal of surgery.

[10]  赤池 弘次,et al.  Statistical analysis and control of dynamic systems , 1988 .

[11]  H. Pfaff,et al.  Surgical safety and overwork , 2004, The British journal of surgery.

[12]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[13]  P. S. Achilles.  THE PSYCHOLOGICAL CORPORATION. , 1923, Science.

[14]  B. Laeng,et al.  A Redrawn Vandenberg and Kuse Mental Rotations Test - Different Versions and Factors That Affect Performance , 1995, Brain and Cognition.

[15]  R. M. Satava,et al.  Metrics for objective Assessment , 2003, Surgical Endoscopy And Other Interventional Techniques.

[16]  R. M. Satava,et al.  Analysis of errors in laparoscopic surgical procedures , 2004, Surgical Endoscopy And Other Interventional Techniques.

[17]  D. Deziel,et al.  Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. , 1993, American journal of surgery.

[18]  A. Darzi,et al.  Objective assessment of technical skills in surgery , 2003, BMJ : British Medical Journal.

[19]  A. Cuschieri,et al.  Errors enacted during endoscopic surgery--a human reliability analysis. , 1998, Applied ergonomics.

[20]  R. Reznick,et al.  Assessing competency in surgery: where to begin? , 2004, Surgery.

[21]  G. Tunnicliffe Wilson,et al.  Statistical analysis and control of dynamic systems , 1988 .

[22]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[23]  R. Satava,et al.  Virtual reality as a metric for the assessment of laparoscopic psychomotor skills , 2002, Surgical Endoscopy And Other Interventional Techniques.

[24]  A. Darzi,et al.  Skills assessment of surgeons. , 2002, Surgery.