Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons

ObjectivesThe objective of the study was to determine whether the metrics from a left-sided laparoscopic colectomy (LC) simulator could distinguish between the objectively scored performance of minimally invasive colorectal expert and novice surgeons. We report our results from the first virtual reality-based laparoscopic colorectal training course for experienced laparoscopic surgeons.MethodsEleven surgeons, experienced but novice in LC, constituted the novice group, and three experienced laparoscopic colorectal surgeons (>300 LCs) served as our experts. Novice subjects received didactic educational sessions and instruction in practice of LC from the experts. All subjects received instruction, demonstration, and supervision on the surgical technique to perform a LC on the simulator. All subjects then performed a laparoscopic colectomy on the simulator. Experts performed the same case as the novices. Outcomes measured by the simulator were time to perform the procedure, instrument path length, and smoothness of the trajectory of the instruments. Anatomy trays from the simulator were objectively scored for explicitly predefined intraoperative errors after each procedure.ResultsExpert surgeons performed significantly better then the novice colorectal surgeons with regard to instrument path length, instrument smoothness, and time taken to complete the procedure. Of the 13 predetermined errors, experts made significantly fewer errors in total then the novices (mean score 2.67 versus 4.7, p = 0.03), and performed better in 8 out of 13 errors.ConclusionThe parameters assessed by the ProMIS VR simulator for laparoscopic colorectal training distinguished between novice and expert colorectal surgeons, despite using otherwise experienced novices who had extensive training before the procedure and expert mentoring during it. Experts performed the simulated procedure significantly faster with more efficient use of their instruments, and made fewer intraoperative errors. Thus the simulator demonstrated construct validity.

[1]  B. Dousset,et al.  The Clinical Outcome of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon Cancer. N Engl J Med 2004;350:2050-2059 , 2004 .

[2]  M. Cadeddu,et al.  Defining a learning curve for laparoscopic colorectal resections , 2001, Diseases of the colon and rectum.

[3]  T. Grantcharov,et al.  Objective assessment of laparoscopic skills using a virtual reality stimulator , 2005, Surgical Endoscopy.

[4]  A. Bandura Social learning theory , 1977 .

[5]  C. Delaney,et al.  Evaluation of the Learning Curve in Laparoscopic Colorectal Surgery: Comparison of Right-Sided and Left-Sided Resections , 2005, Annals of surgery.

[6]  R. M. Satava,et al.  Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training , 2003, Surgical Endoscopy And Other Interventional Techniques.

[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]  Richard M Satava,et al.  Virtual reality surgical simulator: the first steps. 1993. , 2006, Clinical orthopaedics and related research.

[9]  J. Fleshman,et al.  A comparison of laparoscopically assisted and open colectomy for colon cancer. , 2004, The New England journal of medicine.

[10]  Leif Hedman,et al.  Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. , 2007, American journal of surgery.

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

[12]  A. Gallagher,et al.  Virtual Reality Training in Laparoscopic Surgery: A Preliminary Assessment of Minimally Invasive Surgical Trainer Virtual Reality (MIST VR) , 1999, Endoscopy.

[13]  Hernando Cuellar,et al.  Assessment of construct validity of the endoscopic sinus surgery simulator. , 2005, Archives of otolaryngology--head & neck surgery.

[14]  A. G. Gallagher,et al.  Construct validation of the ProMIS simulator using a novel laparoscopic suturing task , 2005, Surgical Endoscopy And Other Interventional Techniques.

[15]  Anthony G Gallagher,et al.  Learning curves and reliability measures for virtual reality simulation in the performance assessment of carotid angiography. , 2006, Journal of the American College of Cardiology.

[16]  R. Veldkamp,et al.  Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomised trial , 2022 .

[17]  R. Beart,et al.  Laparoscopic-assisted colectomy learning curve , 1995, Diseases of the colon and rectum.

[18]  Philip Quirke,et al.  Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial , 2005, The Lancet.

[19]  A. Darzi,et al.  Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomised controlled studies using the MIST VR laparoscopic simulator. , 1998, Studies in health technology and informatics.

[20]  P. Delaney Operative Techniques in Laparoscopic Colorectal Surgery , 2006 .

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

[22]  G Riva,et al.  Applications of Virtual Environments in Medicine , 2003, Methods of Information in Medicine.

[23]  A. Gallagher,et al.  Objective Psychomotor Skills Assessment of Experienced, Junior, and Novice Laparoscopists with Virtual Reality , 2001, World Journal of Surgery.

[24]  A Darzi,et al.  Virtual reality and laparoscopic surgery , 1994, The British journal of surgery.

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