title: Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills.
abstract: BACKGROUND
  The study was carried out to analyze the learning rate for laparoscopic skills on a virtual reality training system and to establish whether the simulator was able to differentiate between surgeons with different laparoscopic experience.
  
  
  METHODS
  Forty-one surgeons were divided into three groups according to their experience in laparoscopic surgery: masters (group 1, performed more than 100 cholecystectomies), intermediates (group 2, between 15 and 80 cholecystectomies), and beginners (group 3, fewer than 10 cholecystectomies) were included in the study. The participants were tested on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) 10 consecutive times within a 1-month period. Assessment of laparoscopic skills included time, errors, and economy of hand movement, measured by the simulator.
  
  
  RESULTS
  The learning curves regarding time reached plateau after the second repetition for group 1, the fifth repetition for group 2, and the seventh repetition for group 3 (Friedman's tests P <0.05). Experienced surgeons did not improve their error or economy of movement scores (Friedman's tests, P >0.2) indicating the absence of a learning curve for these parameters. Group 2 error scores reached plateau after the first repetition, and group 3 after the fifth repetition. Group 2 improved their economy of movement score up to the third repetition and group 3 up to the sixth repetition (Friedman's tests, P <0.05). Experienced surgeons (group 1) demonstrated best performance parameters, followed by group 2 and group 3 (Mann-Whitney test P <0.05).
  
  
  CONCLUSIONS
  Different learning curves existed for surgeons with different laparoscopic background. The familiarization rate on the simulator was proportional to the operative experience of the surgeons. Experienced surgeons demonstrated best laparoscopic performance on the simulator, followed by those with intermediate experience and the beginners. These differences indicate that the scoring system of MIST-VR is sensitive and specific to measuring skills relevant for laparoscopic surgery.
authors.affiliation: Department of Surgical Gastroenterology L, Aarhus University, Kommunehospitalet, Aarhus, Denmark. ttgrant@dadlnet.dk
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
authors.forename: Linda
authors.initials: L
authors.lastname: Bardram
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy; D007858:Learning; D011597:Psychomotor Performance; D013647:Task Performance and Analysis; D014584:User-Computer Interface