title: Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: a randomized controlled trial.
abstract: BACKGROUND
  Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery, requiring extensive training. The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality (VR) simulator to a realistic laparoscopic environment.
  
  
  METHODS
  Twenty surgical trainees underwent basic eye-hand coordination training on a VR simulator (SIMENDO, DelltaTech, Delft, The Netherlands) until predefined performance criteria were met. Then, they were randomized into two groups. Group A (the experimental group) received additional training with the knot-tying module on the simulator, during which they had to tie a double laparoscopic knot ten times. Group B (controls) did not receive additional manual training. Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model. Their performance was captured on digital video and coded. Objective analysis parameters were: time taken to tie the knot and number of predefined errors made. Subjective assessments were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale.
  
  
  RESULTS
  Trainees in group A (n = 9) were significantly faster than the controls (n = 10), with a median of 262 versus 374 seconds (p = 0.034). Group A made a significantly lower number of errors than the controls (median of 24 versus 36 errors, p = 0.030). Subjective assessments by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups.
  
  
  CONCLUSIONS
  Surgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls. The VR module is a useful tool to train laparoscopic knot-tying. Opportunities arose to improve simulator-based instruction that might enhance future training.
authors.affiliation: Department of Biomechanical Engineering, Faculty of Mechanical, Marine and Materials Engineering, Delft University of Technology, Delft, The Netherlands. e.g.g.verdaasdonk@tudelft.nl
authors.forename: E G G
authors.initials: EG
authors.lastname: Verdaasdonk
authors.forename: J
authors.initials: J
authors.lastname: Dankelman
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
authors.forename: L P S
authors.initials: LP
authors.lastname: Stassen
mesh_terms: D000818:Animals; D003162:Competency-Based Education; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D023421:Models, Animal; D009426:Netherlands; D013536:Suture Techniques / Q000193:education*; D013552:Swine; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D014741:Video Recording