title: Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery.
abstract: BACKGROUND
  Surgical training has traditionally been one of apprenticeship. The aim of this review was to determine whether virtual reality (VR) training can supplement and/or replace conventional laparoscopic training in surgical trainees with limited or no laparoscopic experience.
  
  
  METHODS
  Randomized clinical trials addressing this issue were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded, grey literature and reference lists. Standardized mean difference was calculated with 95 per cent confidence intervals based on available case analysis.
  
  
  RESULTS
  Twenty-three trials (mostly with a high risk of bias) involving 622 participants were included in this review. In trainees without surgical experience, VR training decreased the time taken to complete a task, increased accuracy and decreased errors compared with no training. In the same participants, VR training was more accurate than video trainer (VT) training. In participants with limited laparoscopic experience, VR training resulted in a greater reduction in operating time, error and unnecessary movements than standard laparoscopic training. In these participants, the composite performance score was better in the VR group than the VT group.
  
  
  CONCLUSIONS
  VR training can supplement standard laparoscopic surgical training. It is at least as effective as video training in supplementing standard laparoscopic training.
authors.affiliation: Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, University College London and Royal Free Hospital NHS Trust, London NW32QG, UK. kurinchi2k@hotmail.com
authors.forename: K
authors.initials: K
authors.lastname: Gurusamy
authors.forename: R
authors.initials: R
authors.lastname: Aggarwal
authors.forename: L
authors.initials: L
authors.lastname: Palanivelu
authors.forename: B R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D016032:Randomized Controlled Trials as Topic