Using a Dynamic Training Environment to Assess Laparoscopic Skill

Current physical laparoscopic surgical simulators contain only static tasks, which do not develop the advanced hand-eye coordination skills needed to navigate the dynamic surgical environment. A dynamic minimally invasive training environment (DynaMITE) was developed to fill this need. Preliminary testing showed a potential for the device to improve the hand-eye coordination skills of even expert surgeons. To further evaluate the utility of the device as a training and skill assessment tool, a study was performed with a second-generation device. Forty-two subjects at the SAGES 2007 Learning Center participated. Their experience ranged from naïve (0-10 laparoscopic procedures performed) to highly experienced (more than 2500 procedures performed). Each subject completed a minimum of one trial each of two tasks: 1) an aim-and-point task, which required making contact with an array of five small vertical pins, and 2) an acquire-place task, which required transferring three objects (a cylinder, a triangular prism, and an asymmetric shape) from holders on one side of the platform to another. Both task targets moved at one of three speeds: static, slow, or fast. Data analysis using two-factor analysis of variance (ANOVA) showed a significant main effect in time to task completion for the factors of movement (p=0.015) and experience (p=0.048), in the aim-and-point task. On average, subjects were faster in the static and slow tasks than fast task (5.9±2.9, 5.9±3.1, 8.05±2.6 s, respectively). Similarly, subjects made fewer misses in the static and slow tasks than fast task (18.9±18.2%, 27.4±27.7%, 53.7±29.9%, respectively, p=0.024). In the acquire-place task, ANOVA showed a significant main effect in time to task completion for the factors of shape (p=0.001) and experience (p=0.049). On average, cylinders were transferred faster than triangular prism or asymmetric shapes (16.4±13.2, 65.9±77.6, 73.7±90.3 s, respectively). These results suggest that DynaMITE may be useful for training more advanced hand-eye coordination skills, but remain to be validated in a more controlled testing environment.

Session: Podium Presentation

Program Number: S051

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