title: The LapSim: a learning environment for both experts and novices.
abstract: BACKGROUND
  Simulated environments present challenges to both clinical experts and novices in laparoscopic surgery. Experts and novices may have different expectations when confronted with a novel simulated environment. The LapSim is a computer-based virtual reality laparoscopic trainer. Our aim was to analyze the performance of experienced basic laparoscopists and novices during their first exposure to the LapSim Basic Skill set and Dissection module.
  
  
  METHODS
  Experienced basic laparoscopists (n=16) were defined as attending surgeons and chief residents who performed >30 laparoscopic cholecystectomies. Novices (n=13) were surgical residents with minimal laparoscopic experience. None of the subjects had used a computer-based laparoscopic simulator in the past. Subjects were given one practice session on the LapSim tutorial and dissection module and were supervised throughout the testing. Instrument motion, completion time, and errors were recorded by the LapSim. A Performance Score (PS) was calculated using the sum of total errors and time to task completion. A Relative Efficiency Score (RES) was calculated using the sum of the path lengths and angular path lengths for each hand expressed as a ratio of the subject's score to the worst score achieved among the subjects. All groups were compared using the Kruskal-Wallis and Mann-Whitney U-test.
  
  
  RESULTS
  Novices achieved better PS and/or RES in Instrument Navigation, Suturing, and Dissection (p<0.05). There was no difference in the PS and RES between experts and novices in the remaining skills.
  
  
  CONCLUSIONS
  Novices tended to have better performance compared to the experienced basic laparoscopists during their first exposure to the LapSim Basic Skill set and Dissection module.
authors.affiliation: Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Ro
authors.forename: Ioannis K
authors.initials: IK
authors.lastname: Toumpoulis
authors.forename: Robert C
authors.initials: RC
authors.lastname: Ashton
authors.forename: Tony
authors.initials: T
authors.lastname: Jebara
authors.forename: Caroline
authors.initials: C
authors.lastname: Schulman
authors.forename: George J
authors.initials: GJ
authors.lastname: Todd
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Derose
authors.forename: James J
authors.initials: JJ
authors.lastname: McGinty
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D007318:Inservice Training; D007396:Internship and Residency; D010535:Laparoscopy; D013647:Task Performance and Analysis; D014584:User-Computer Interface