title: Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy.
abstract: OBJECTIVE
  To assess the first commercially available virtual reality (VR) simulator to incorporate procedural modules for training of inexperienced gynaecological surgeons to perform laparoscopic salpingectomy for ectopic pregnancy.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Departments of surgery and gynaecology in central London teaching hospitals.
  
  
  METHODS
  Thirty gynaecological surgeons were recruited to the study, and were divided into novice (<10 laparoscopic procedures), intermediate (20-50) and experienced (>100) groups.
  
  
  METHODS
  All subjects were orientated to the VR simulator with a basic skills task, followed by performing ten repetitions of the virtual ectopic pregnancy module, in a distributed manner.
  
  
  METHODS
  Operative performance was assessed by the time taken to perform surgery, blood loss and total instrument path length.
  
  
  RESULTS
  There were significant differences between the groups at the second repetition of the ectopic module for time taken (median 551.1 versus 401.2 versus 249.2 seconds, P = 0.001), total blood loss (median 304.2 versus 187.4 versus 123.3 ml, P = 0.031) and total instrument path length (median 17.8 versus 8.3 versus 6.8 m, P = 0.023). The learning curves of the experienced operators plateaued at the second session, although greater numbers of sessions were necessary for intermediate (seven) and novice (nine) surgeons to achieve similar levels of skill.
  
  
  CONCLUSIONS
  Gynaecological surgeons with minimal laparoscopic experience can improve their skills during short-phase training on a VR procedural module. In contrast, experienced operators showed nonsignificant improvements. Thus, VR simulation may be useful for the early part of the learning curve for surgeons who wish to learn to perform laparoscopic salpingectomy for ectopic pregnancy.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, London, UK. rajesh.aggarwal@imperial.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: A
authors.initials: A
authors.lastname: Tully
authors.forename: T
authors.initials: T
authors.lastname: Grantcharov
authors.forename: C R
authors.initials: CR
authors.lastname: Larsen
authors.forename: T
authors.initials: T
authors.lastname: Miskry
authors.forename: A
authors.initials: A
authors.lastname: Farthing
authors.forename: A
authors.initials: A
authors.lastname: Darzi
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005187:Fallopian Tubes / Q000601:surgery*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000592:standards; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000601:surgery*; D011446:Prospective Studies; D013663:Teaching / Q000379:methods