J. McGuigan

Objective Psychomotor Skills Assessment of Experienced, Junior, and Novice Laparoscopists with Virtual Reality

Objective assessment of psychomotor skills in surgery is now a priority; however, this assessment is difficult to achieve because of measurement difficulties associated with the reliability and validity of assessing surgical skills in vivo and in the laboratory. In this study virtual reality (VR) was used to overcome these problems in the objective psychomotor assessment of senior, junior, and novice laparoscopists. Twelve experienced laparoscopic surgeons (performed >50 Minimal Access Surgery (MAS) procedures), 12 inexperienced laparoscopic surgeons (<10 MAS procedures), and 12 laparoscopic novices (no MAS procedures) participated in the study. Each subject completed all six tasks of the Minimally Invasive Surgical Trainer; Virtual Reality (MIST VR). In comparison to the other groups, experienced laparoscopic surgeons performed the tasks significantly (p < 0.01) faster, had a lower error rate, were more economic in their movement of surgical instruments and in the use of diathermy. As a group they also showed greater consistency in their performance. MIST VR distinguished between the three groups of laparoscopists. VR provides a useful objective assessment tool for evaluating psychomotor skills for laparoscopic surgery.

Virtual reality training leads to faster adaptation to the novel psychomotor restrictions encountered by laparoscopic surgeons

Abstract Background: The fulcrum effect of the body wall on instrument handling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons. This study evaluated three types of laparoscopic simulator training to assess their ability to promote the users adaptation to the fulcrum effect. Methods: Thirty-two participants with no previous experience in laparoscopic surgery were randomly assigned to one of four groups representing different training conditions. One group was assigned to use a virtual reality simulator (MIST VR); two others were given a laparoscopic Z or U maze-tracking task. The control group received no training. Subjects were asked to perform a 2-min laparoscopic cutting task under normal laparoscopic imaging conditions first before and then after training. Results: In the test trial, subjects who trained on MIST VR made significantly more correct incisions (p <0.0001) and fewer incorrect incisions (p <0.0001). Conclusion: Training on a virtual reality simulator such as MIST VR helps laparoscopic novices adapt to the fulcrum effect faster.

A case-control comparison of traditional and virtual-reality training in laparoscopic psychomotor performance

Learning hand-eye coordination is a crucial part of the training programme for junior laparoscopic surgeons. This study compares laparoscopic psychomotor performance from traditional standard abdominal box-training and virtual-reality training. Twenty-four right-hand dominant subjects with no experience in laparoscopy were required to complete a novel laparoscopic task. Eight subjects completed all six tasks on the Minimally Invasive Surgical Trainer Virtual Reality (MIST VR) training program. Another 16 subjects were case-matched to these subjects for gender, sight-corrected status and age (± 2 years). Eight of these subjects spent the same amount of time as their yoked MIST VR counterpart training on a traditional laparoscopic cutting task. The other eight subjects, the control group, received no training. Individuals who trained on the MIST VR program made significantly more correct incisions than their case-matched counterparts in the standard trained group (p < 0.05) and control group (p < 0.0001) and were also significantly more likely to use both hands to perform the task (p < 0.02). Virtual reality appears to offer potential as a laparoscopic laboratory-training tool for the acquisition of psychomotor skills that transfer to novel laparoscopic tasks.