title: The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation.
abstract: BACKGROUND
  Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic suturing training.
  
  
  METHODS
  All participants of several European Association for Endoscopic Surgery (EAES)-approved laparoscopic skills courses (N = 45) filled out a questionnaire on their opinion on laparoscopic suturing training. Additionally, participants with little or no laparoscopic suturing experience were allotted to two groups: group A (N = 10), who started training on the box trainer and subsequently the VR simulator (SimSurgery), and group B (N = 10), who began on the VR simulator followed by the box. Finally, suturing and knot-tying skills were assessed by an expert observer, using a standard evaluation form (eight items on five-point-Likert scale). The same was done after the initial training on the box in group A, as a control. Significant differences were calculated with the independent-sample t-test and the paired t-test.
  
  
  RESULTS
  The total score of group A was higher than both group B and control (means of 30.80, 27.60, 28.20, respectively), but not significantly. The only tendency to a significant difference between group A and B was found in 'taking proper bites' (mean 4.10 versus 3.60, p = 0.054). All the participants scored the features of the box trainer significantly higher than those of the VR simulator (p < 0.001), 46.7% was of the opinion that the box alone would be sufficient for laparoscopic suturing training.
  
  
  CONCLUSIONS
  From this study we can conclude that VR simulation does not have a significant additional value in laparoscopic suturing training, over traditional box trainers. One should consider that the future development in VR simulation should focus on basic skills and component tasks of procedural training in laparoscopic surgery, rather than laparoscopic suturing.
authors.affiliation: Catharina Hospital, Eindhoven, The Netherlands. S.Botden@student.unimaas.nl
authors.forename: Sanne M B I
authors.initials: SM
authors.lastname: Botden
authors.forename: Fawaz
authors.initials: F
authors.lastname: Torab
authors.forename: Sonja N
authors.initials: SN
authors.lastname: Buzink
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jakimowicz
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D005260:Female; D013502:General Surgery / Q000193:education* / Q000379:methods; D006176:Gynecology / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D011597:Psychomotor Performance; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000193:education* / Q000523:psychology; D055698:Touch Perception; D014584:User-Computer Interface