Assessment of laparoscopic surgical skills acquired on laparoscopic virtual reality simulator compared to box trainer: an analysis of obstetrics-gynaecology residents

Background: Laparoscopic surgery requires very different set of psychomotor skills compared to open surgery, such as working in three-dimensional environment with two-dimensional view, four instead of six degrees of freedom, eye-hand coordination, depth perception and bimanual manipulation. Laparoscopic surgical training using laparoscopic simulators overcomes these inherent differences and improves efficiency of learning and patient safety. The aim of this study was to compare the effectiveness of virtual reality (VR) simulator and box-trainer and determine whether one has advantages over the other as training tool for relatively simple laparoscopic procedures. Methods: A prospective, randomized, blinded, comparative trial enrolled 20 residents in Obstetrics and Gynaecology with minimal laparoscopic experiences to participate in practical exercises with either virtual reality (LapVR) simulator (group-A), or laparoscopic Box-Trainer (group-B). The candidates acted as their own control. Subjects within one group were not allowed to practice, on the opposing trainers. Initial teaching session was given to obtain all participants familiarization with the virtual reality simulator and they carried out laparoscopic salpingotomy and laparoscopic salpingectomy for ectopic pregnancy on LapVR (pretest). Performance was recorded by LapVR for parameters of total time taken, time of cautery used, total blood loss and economy of motion. The subjects were then randomized to either group-A or group-B for series of laparoscopic exercises. The residents of group-A were practiced on LapVR in laparoscopic peg transfer, clipping and cutting and certain parameters were assessed by LapVR. The practical exercises on laparoscopic Trainer-Box were based in the tasks of “ovarian cystectomy” and “salpingotomy” for ectopic pregnancy and they were captured on DVD and scored for time and accuracy by a blinded expert investigator. After 2-day sessions lasting one and half hours each, all subjects were reassessed on the initial same procedures on LapVR (post-test). Results: Both groups showed improvement after their training tasks. Performance of two groups was comparable before and after training for both laparoscopic ectopic pregnancy procedures on LapVR. The participants’ satisfaction according to post-training questionnaire was high for the training modality as a whole and showed no differences between groups. Conclusions: Neither LapVR nor Box-Trainer simulator showed any superiority over other for training laparoscopic skills to novice learners. Laparoscopic training laboratories in laparoscopic training hospitals could include virtual reality simulators as reasonable alternative to Box-Trainer simulators for laparoscopic training of inexperienced residents in laparoscopy