title: Construct validity of the LapVR virtual-reality surgical simulator.
abstract: BACKGROUND
  Laparoscopic surgery requires fundamental skills peculiar to endoscopic procedures such as eye-hand coordination. Acquisition of such skills prior to performing actual surgery is highly desirable for favorable outcome. Virtual-reality simulators have been developed for both surgical training and assessment of performance. The aim of the current study is to show construct validity of a novel simulator, LapVR (Immersion Medical, San Jose, CA, USA), for Japanese surgeons and surgical residents.
  
  
  METHODS
  Forty-four subjects were divided into the following three groups according to their experience in laparoscopic surgery: 14 residents (RE) with no experience in laparoscopic surgery, 14 junior surgeons (JR) with little experience, and 16 experienced surgeons (EX). All subjects executed "essential task 1" programmed in the LapVR, which consists of six tasks, resulting in automatic measurement of 100 parameters indicating various aspects of laparoscopic skills.
  
  
  RESULTS
  Time required for each task tended to be inversely correlated with experience in laparoscopic surgery. For the peg transfer skill, statistically significant differences were observed between EX and RE in three parameters, including total time and average time taken to complete the procedure and path length for the nondominant hand. For the cutting skill, similar differences were observed between EX and RE in total time, number of unsuccessful cutting attempts, and path length for the nondominant hand. According to the programmed comprehensive evaluation, performance in terms of successful completion of the task and actual experience of the participants in laparoscopic surgery correlated significantly for the peg transfer (P=0.007) and cutting skills (P=0.026).
  
  
  CONCLUSIONS
  The peg transfer and cutting skills could best distinguish between EX and RE. This study is the first to provide evidence that LapVR has construct validity to discriminate between novice and experienced laparoscopic surgeons.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan. iwt-nk@med.nagoya-u.ac.jp
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwata
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Chie
authors.initials: C
authors.lastname: Tanaka
authors.forename: Norifumi
authors.initials: N
authors.lastname: Ohashi
authors.forename: Goro
authors.initials: G
authors.lastname: Nakayama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004724:Endoscopy / Q000193:education / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D020706:Laparoscopes; D010535:Laparoscopy / Q000193:education / Q000379:methods*; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data; D008875:Middle Aged; D018709:Statistics, Nonparametric; D014584:User-Computer Interface