The Impact of a Fundamentals of Laparoscopic Surgery and Virtual Reality Training Program On Surgical Performance, a Blinded Randomized Validation Trial

S B Goldin, MD PhD, H Lomas Iv, MPAS PAC MSIV, R E Heithaus, MS MSIV, D Molloy, MS MSIV, J R Williams, MD, D Donohue, MS MSIV, J Groundland, PT MSIV, S Schnaus, MS MSII, JJ Mateka, MS MSII, R Singh, MD, M T Brannick, PhD. The University of South Florida College of Medicine, Tampa FL

Introduction: Simulation is increasingly used in surgical training. Virtual reality trainers have advantages in data collection and information presentation over inexpensive box trainers for the development of perceptual and motor skills required for laparoscopic surgery. Our aim was to determine whether VR training was superior to box trainers in training novice laparoscopists..

Methods: We compared the performance of those randomly assigned to box training in 10 two-hour sessions or to a box trainer in 5 two-hour sessions, augmented by a virtual reality trainer for an additional 5 two-hour sessions. All participants completed a laparoscopic cholecystectomy on a porcine liver-gallbladder prosection before training and again after training. All operations were video recorded. Skill was evaluated using the GOALS scoring system rated by a blinded expert. Of the 39 participants who completed the training, 7 were fourth year medical students, 32 were 1st-year surgical residents, and 36 were right handed. None had prior experience as an operative surgeon for laparoscopic cholecystectomy and none had any significant prior laparoscopic experience. No participant had any prior simulation experience.

Results: Analysis of covariance was used to test whether there was a difference on the posttest by training condition using the pretest as a covariate. Neither the training effect nor the covariate was significant for the analysis of covariance. Therefore, the two training groups were combined, and a dependent t-test was used to compare the means from pretest to posttest. Results showed a statistically and practically significant improvement in surgical performance after training (t = 4.17, p < .01 , d = .67).

Conclusions: The VR trainer did not produce a detectable amount of augmented skill over the box trainer under the conditions of this study. Both training methods were effective in improving surgical skill as measured by prosection, and therefore the box trainer continues to be a useful and inexpensive tool for developing perceptual and motor skills.

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