title: Development of a model for training and evaluation in subfascial endoscopic perforator surgery (SEPS).
abstract: We describe a training method with objective evaluation that enhances video-assisted surgical skills. Training is via a simulator for subfascial endoscopic perforator surgery (SEPS) and can assess whether specific training exercises are helpful in the acquisition of skills for video-assisted surgical techniques. Twenty-five surgeons, with or without experience in video-assisted surgical techniques, were asked to perform standardised drills connected with the SEPS technique. The SEPS simulator consisted of an artificially constructed subfascial space in a leg, in which false perforator veins had to be localised, clipped and cut. The participants performed two sequences of actions three times, in order to improve their dexterity. The time required to perform each sequence was recorded. All trainees showed a steady improvement in skill-acquisition of the SEPS technique; the difference was statistically significant (p < 0.004). Despite its obvious importance in teaching programmes, the assessment and training of technical ability has not been fully developed. If virtual reality simulators are to become more important in the future, simulation models will have to approximate more closely the real operating theatre, and thus will become more valid in the training and evaluation of surgical technique.