Basic laparoscopic training using the Simbionix LAP Mentor: setting the standards in the novice group.

BACKGROUND Virtual reality devices are becoming the backbone for laparoscopic training in surgery. However, without knowledge of the achievable metrics of basic training within the trainee group, these simulators cannot be used effectively. Currently, no validated task metrics of the performance of larger trainee groups are available. STUDY DESIGN From April 2004 to December 2009, we collated an extensive prospective database using the Simbionix LAP Mentor (Simbionix USA, Cleveland, Ohio) for basic laparoscopic training of novice surgeons. This database was used to determine benchmarks for basic skill exercises and procedural tasks that combine stimulus to improve and feasibility with acceptance of the training program and the goal to train for safe surgery. RESULTS In all, 18,996 task performances of 286 novice trainees were analyzed. For the basic skill exercises, the total time for correct execution ranged between 45 seconds for basic skill 3 (eye-hand coordination) and 269 seconds for basic skill 9 (object placement). For the procedural tasks, the total time for correct execution ranged between 68 seconds for procedural task 1 (clipping and cutting) and 256 seconds for procedural task 3 (dissection). The total time to task completion depended mainly on right instrument path length with high correlation to left instrument path length. Learning curve analyses of the 4 procedural tasks demonstrated performance plateaus after 10-15 repetitions. Most complications occurred during the initial repetitions of the respective task. The best quartile of performances was chosen as peer group benchmark because it provides sufficient stimulus for improvement without discouraging trainees, thus enhancing adherence to the training program. The benchmark for safety and accuracy parameters was set at a predefined level of 95% correct execution. CONCLUSIONS As experience with virtual reality (VR) training is growing, curricula must be based on benchmarks for efficient training derived from large trainee groups to optimize use of the still costly simulators. Safety parameters should be included in trainee assessment. We share a set of metrics that take into account both performance and feasibility for basic laparoscopic training of surgical novices using the Simbionix LAP Mentor.

[1]  B. L. Welch.  ON THE COMPARISON OF SEVERAL MEAN VALUES: AN ALTERNATIVE APPROACH , 1951 .

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

[3]  Marlies P. Schijven,et al.  European consensus on a competency-based virtual reality training program for basic endoscopic surgical psychomotor skills , 2010, Surgical Endoscopy.

[4]  Rajesh Aggarwal,et al.  Assessment and feedback in the skills laboratory and operating room. , 2010, The Surgical clinics of North America.

[5]  Rajesh Aggarwal,et al.  Deliberate Practice on a Virtual Reality Laparoscopic Simulator Enhances the Quality of Surgical Technical Skills , 2011, Annals of surgery.

[6]  Jeffrey A. Cadeddu,et al.  Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure. , 2008, The Journal of urology.

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

[8]  Teodor P Grantcharov,et al.  Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition. , 2009, American journal of surgery.

[9]  Paul G Gauger,et al.  Laparoscopic Skills Are Improved With LapMentor™ Training: Results of a Randomized, Double-Blinded Study , 2006, Annals of surgery.

[10]  Sabha Ganai,et al.  Virtual-reality training improves angled telescope skills in novice laparoscopists. , 2007, American journal of surgery.

[11]  Dallas E. Johnson,et al.  Analysis of messy data , 1992 .

[12]  W. J. Conover,et al.  Practical Nonparametric Statistics , 1972 .

[13]  Rajesh Aggarwal,et al.  A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. , 2006, American journal of surgery.

[14]  E Mühe,et al.  Long-term follow-up after laparoscopic cholecystectomy. , 1992, Endoscopy.

[15]  Aimin Zhang,et al.  Construct validity testing of a laparoscopic surgery simulator (Lap Mentor®) , 2008, Surgical Endoscopy.

[16]  Michael H. Kutner.  Applied Linear Statistical Models , 1974 .

[17]  Dimitrios Stefanidis,et al.  Challenges during the implementation of a laparoscopic skills curriculum in a busy general surgery residency program. , 2008, Journal of surgical education.

[18]  A. Darzi,et al.  Development of a virtual reality training curriculum for laparoscopic cholecystectomy , 2009, The British journal of surgery.

[19]  John R. Wolberg,et al.  Data Analysis Using the Method of Least Squares: Extracting the Most Information from Experiments , 2005 .

[20]  Rajesh Aggarwal,et al.  Warm-up in a Virtual Reality Environment Improves Performance in the Operating Room , 2010, Annals of surgery.

[21]  M. Schijven,et al.  Face validation of the Simbionix LAP Mentor virtual reality training module and its applicability in the surgical curriculum , 2007, Surgical Endoscopy.

[22]  Morton B. Brown,et al.  Robust Tests for the Equality of Variances , 1974 .

[23]  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.

[24]  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.

[25]  S. Siegel,et al.  Nonparametric Statistics for the Behavioral Sciences , 2022, The SAGE Encyclopedia of Research Design.

[26]  Teodor P Grantcharov,et al.  Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. , 2003, American journal of surgery.