title: Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator.
abstract: BACKGROUND
  Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic instruments are used within an hybrid mannequin on tissue or objects while using video tracking. This study was designed to assess the difference in realism, haptic feedback, and didactic value between AR and VR laparoscopic simulation.
  
  
  METHODS
  The ProMIS AR and LapSim VR simulators were used in this study. The participants performed a basic skills task and a suturing task on both simulators, after which they filled out a questionnaire about their demographics and their opinion of both simulators scored on a 5-point Likert scale. The participants were allotted to 3 groups depending on their experience: experts, intermediates and novices. Significant differences were calculated with the paired t-test.
  
  
  RESULTS
  There was general consensus in all groups that the ProMIS AR laparoscopic simulator is more realistic than the LapSim VR laparoscopic simulator in both the basic skills task (mean 4.22 resp. 2.18, P < 0.000) as well as the suturing task (mean 4.15 resp. 1.85, P < 0.000). The ProMIS is regarded as having better haptic feedback (mean 3.92 resp. 1.92, P < 0.000) and as being more useful for training surgical residents (mean 4.51 resp. 2.94, P < 0.000).
  
  
  CONCLUSIONS
  In comparison with the VR simulator, the AR laparoscopic simulator was regarded by all participants as a better simulator for laparoscopic skills training on all tested features.
authors.affiliation: Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 ZA Eindhoven, The Netherlands.
authors.forename: Sanne M B I
authors.initials: SM
authors.lastname: Botden
authors.forename: Sonja N
authors.initials: SN
authors.lastname: Buzink
authors.forename: Marlies P
authors.initials: MP
authors.lastname: Schijven
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jakimowicz
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004502:Education, Medical, Continuing / Q000379:methods* / Q000592:standards*; D004867:Equipment Design; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D013536:Suture Techniques / Q000592:standards; D014584:User-Computer Interface