title: Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality.
abstract: BACKGROUND
  Very few studies have addressed the transferability of skills from virtual reality (VR) to real life. The aim of this study was to assess the feasibility and effectiveness of teaching intracorporeal knot tying (ICKT) by VR simulation only.
  
  
  METHODS
  Twenty novices underwent structured training of basic skills training on the Minimally Invasive Surgical Trainer simulator (Mentice AB, Gothenburg, Sweden) followed by knot tying training on the LapSim simulator (Surgical Science, Gothenburg, Sweden). They were assessed pre- and post-training on a video trainer. Assessment of performance included motion tracking and video-based checklist. Nonparametric statistical analysis was used, and P < .05 was deemed significant.
  
  
  RESULTS
  All participants completed a correct knot as compared with only 25% before VR training. Time to completion was 66% faster and knot quality 45% better after VR training. Significant reduction in number of movements (P = .006) and distance traveled (P < .000) by both hands after VR training.
  
  
  CONCLUSIONS
  Teaching ICKT by VR simulators only is feasible and effective. Furthermore, this study highlights the complementary use of different VR simulators within a structured curriculum.
authors.affiliation: Department of General Surgery and Tranplantion, The Chaim Sheba Medical Centre, MSR, Tel Hashomer, 52621 Ramat Gan, Israel. dr.munz@012.net.il
authors.forename: Yaron
authors.initials: Y
authors.lastname: Munz
authors.forename: Alex M
authors.initials: AM
authors.lastname: Almoudaris
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Dosis
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Liddle
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D016544:Patient Simulation; D013337:Students, Medical; D013536:Suture Techniques / Q000193:education*; D014584:User-Computer Interface; D014741:Video Recording