Laparoscopy
Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies

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Abstract

Background

Virtual reality (VR) training has been shown previously to improve intraoperative performance during part of a laparoscopic cholecystectomy. The aim of this study was to assess the effect of proficiency-based VR training on the outcome of the first 10 entire cholecystectomies performed by novices.

Methods

Thirteen laparoscopically inexperienced residents were randomized to either (1) VR training until a predefined expert level of performance was reached, or (2) the control group. Videotapes of each resident’s first 10 procedures were reviewed independently in a blinded fashion and scored for predefined errors.

Results

The VR-trained group consistently made significantly fewer errors (P = .0037). On the other hand, residents in the control group made, on average, 3 times as many errors and used 58% longer surgical time.

Conclusions

The results of this study show that training on the VR simulator to a level of proficiency significantly improves intraoperative performance during a resident’s first 10 laparoscopic cholecystectomies.

Section snippets

Subjects

Thirteen surgical residents (6 men, 7 women) from 9 different institutions in Sweden participated in this study. The introduction to laparoscopy training in the Swedish education system varies and the subjects therefore differed with respect to their experience from postgraduate year 1 to 2. They all had experience in assisting with laparoscopic procedures but had no previous experience in performing an LC. All residents were scheduled to start with laparoscopic training and each supervisor

Results

A total of 120 cholecystectomies were registered within the frame of this study. Eleven trainees performed 10 procedures each and 1 trainee in each group performed 5 each for local logistical reasons. For these latter 2 trainees, surgeries 1 and 5 were assessed. In total, 37 procedures were reviewed. Three observed procedures in the control group were converted to open surgeries.

There was no significant difference between the 2 groups concerning baseline parameters (ie, sex, age, postgraduate

Comments

In this study we objectively assessed, in a prospective blinded fashion, the intraoperative errors of 13 residents who performed 120 LCs. Half of these procedures were performed by residents who had first shown laparoscopic technical proficiency on the LapSim VR simulator before performing surgery. The results of this study indicate that the VR-trained group performed to a significantly higher degree during their first 10 LCs, as compared with the control group. Subjects in the control group

Conclusions

In conclusion, we believe that the results in this study show that skills acquired in the LapSim simulator improve the initial learning curve in LCs, and that the system is clinically validated for this purpose. It also is clear that all new laparoscopists should train on the simulator until they reach the established proficiency level, before performing laparoscopically on patients. Furthermore, our results support the ongoing implementation of simulation technology into the medical training

Acknowledgment

The authors thank Jakob Bergström at the Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, for all help with the statistical analysis.

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