title: Preliminary study of virtual reality and model simulation for learning laparoscopic suturing skills.
abstract: OBJECTIVE
  Repetitive practice of laparoscopic suturing and knot tying can facilitate surgeon proficiency in performing this reconstructive technique. We compared a silicone model and pelvic trainer to a virtual reality simulator in the learning of laparoscopic suturing and knot tying by laparoscopically naïve medical students, and evaluated the subsequent performance of porcine laparoscopic cystorrhaphy.
  
  
  METHODS
  A total of 20 medical students underwent a 1-hour didactic session with video demonstration of laparoscopic suturing and knot tying by an expert laparoscopic surgeon. The students were randomized to a pelvic trainer (10) or virtual reality simulator (10) for a minimum of 2 hours of laparoscopic suturing and knot tying training. Within 1 week of the training session the medical students performed laparoscopic closure of a 2 cm cystotomy in a porcine model. Objective structured assessment of technical skills for laparoscopic cystorrhaphy was performed at the procedure by laparoscopic surgeons blinded to the medical student training format. A video of the procedure was evaluated with an objective structured assessment of technical skills by an expert laparoscopic surgeon blinded to medical student identity and training format. The medical students completed an evaluation questionnaire regarding the training format after the laparoscopic cystorrhaphy.
  
  
  RESULTS
  All students were able to complete the laparoscopic cystorrhaphy. There was no difference between the pelvic trainer and virtual reality groups in mean +/- SD time to perform the porcine cystorrhaphy at 40 +/- 15 vs 41 +/- 10 minutes (p = 0.87) or the objective structured assessment of technical skills score of 8.8 +/- 2.3 vs 8.2 +/- 2.2 (p = 0.24), respectively. Bladder leak occurred in 3 (30%) of the pelvic trainer trained and 6 (60%) of the virtual reality trained medical student laparoscopic cystorrhaphy procedures (Fisher exact test p = 0.37). The only significant difference between the 2 groups was that 4 virtual reality trained medical students considered the training session too short compared to none of those trained on the pelvic trainer (p = 0.04).
  
  
  CONCLUSIONS
  There is no significant difference between the pelvic trainer and virtual reality trained medical students in proficiency to perform laparoscopic cystorrhaphy in a pig model, although both groups require considerably more training before performing this procedure clinically. The pelvic trainer training may be more user-friendly for the novice surgeon to begin learning these challenging laparoscopic skills.
authors.affiliation: Department of Urology, University of California, Irvine, Orange, California, USA. elspethm@uci.edu
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Surendra B
authors.initials: SB
authors.lastname: Kolla
authors.forename: Rosanne T
authors.initials: RT
authors.lastname: Santos
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gan
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.forename: Michael K
authors.initials: MK
authors.lastname: Louie
authors.forename: Aldrin J R
authors.initials: AJ
authors.lastname: Gamboa
authors.forename: Adam G
authors.initials: AG
authors.lastname: Kaplan
authors.forename: Ross M
authors.initials: RM
authors.lastname: Moskowitz
authors.forename: Lorena A
authors.initials: LA
authors.lastname: Andrade
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Skarecky
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Osann
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000328:Adult; D000818:Animals; D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy; D008953:Models, Anatomic; D023421:Models, Animal; D013536:Suture Techniques / Q000193:education*; D013552:Swine; D001743:Urinary Bladder / Q000601:surgery*; D014584:User-Computer Interface; D055815:Young Adult