title: Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery.
abstract: OBJECTIVE
  The aim of this study was to compare learning curves for laparoscopic cholecystectomy (LC) after training on a proficiency based virtual reality (VR) curriculum with that of a traditionally trained group.
  
  
  BACKGROUND
  Simulator-based training has been shown to improve technical performance during real laparoscopic procedures, although research to date has not proven the persistence of this effect over subsequent cases.
  
  
  METHODS
  Twenty novice surgeons underwent baseline laparoscopic skills testing followed by a 1-day didactic training session. Control subjects (n = 10) performed 5 cadaveric porcine LCs each; VR-trained subjects (n = 10) completed a VR training curriculum followed by 3 porcine LCs each. A further 10 experienced laparoscopic surgeons (>100 LCs) performed 2 porcine LCs each to define benchmark levels. Technical skill assessment was by motion analysis and video-based global rating scores (out of 35).
  
  
  RESULTS
  There were no intergroup differences in baseline skill. The first LC revealed significant differences between control and VR groups for time (median 4590 seconds vs. 2165 seconds, P = 0.038), path length (169.2 meters vs. 86.8 meters, P = 0.009), number of movements (2446 vs. 1029, P = 0.009), and video scores (17 vs. 25, P = 0.001). The VR group, although not a control, achieved video and dexterity scores equivalent to expert levels of performance.
  
  
  CONCLUSIONS
  A proficiency based VR training curriculum shortens the learning curve on real laparoscopic procedures when compared with traditional training methods. This may be a more cost- and time-effective approach, and supports the need for simulator-based practice to be integrated into surgical training programs.
authors.affiliation: Department of Biosurgery and Surgical Technology, Imperial College London, United Kingdom. rajesh.aggarwal@imperial.ac.uk
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Jonnie
authors.initials: J
authors.lastname: Ward
authors.forename: Indran
authors.initials: I
authors.lastname: Balasundaram
authors.forename: Parvinderpal
authors.initials: P
authors.lastname: Sains
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods*; D003194:Computer-Assisted Instruction; D013502:General Surgery / Q000193:education*; D006801:Humans; D008954:Models, Biological; D011214:Practice, Psychological; D013552:Swine; D013997:Time Factors; D014584:User-Computer Interface