title: Virtual reality laparoscopic skill assessment in microgravity.
abstract: BACKGROUND
  The objective of the study was to assess if performance of basic laparoscopic skills on a virtual reality (VR) simulator is impaired in microgravity relative to normal gravitational influences.
  
  
  METHODS
  Fourteen subjects with various educational backgrounds underwent basic laparoscopy skill training for five consecutive days on the ground before flying aboard NASA's KC-135 zero-gravity laboratory. The participants performed basic laparoscopic exercises (clip applying, grasping, cutting, and suturing) on a VR laparoscopy simulator, both on the ground and during 25-s microgravity windows in parabolic flight. Skill levels after ground training were compared with skill levels in performing the same tasks in microgravity. Blinded reviewers measured the number of tasks successfully completed, tissue damage number, left and right hand path lengths during task execution, and percentage of task attempts that resulted in successful completion.
  
  
  RESULTS
  A significant increase in tissue injury (t test, P < 0.05) and task erosion were seen in clip applying, cutting, and grasping in microgravity (45%, 20% and 57% decrease in task attempts that resulted in a successful completion, respectively). However, there was no significant difference in the left and right hand path lengths, and the total number of tasks successfully completed on the ground versus in microgravity, for any of the four laparoscopic exercises (t test, P > 0.05).
  
  
  CONCLUSIONS
  This study demonstrates decreased efficiency and increased injury to the simulated tissues in performing laparoscopic skills during microgravity as compared to performing these skills in standard gravitational influence. Additional experiments are indicated to further develop and validate VR microgravity surgical simulation.
authors.affiliation: Department of Surgery, Saint Mary's Hospital, Waterbury, Connecticut, USA.
authors.forename: Lucian
authors.initials: L
authors.lastname: Panait
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Merrell
authors.forename: Azhar
authors.initials: A
authors.lastname: Rafiq
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Dudrick
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Broderick
mesh_terms: D000401:Aircraft; D018480:Astronauts / Q000193:education*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D003194:Computer-Assisted Instruction; D013502:General Surgery / Q000193:education* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D013525:Surgical Instruments; D014584:User-Computer Interface; D014893:Weightlessness