title: Effectiveness of laparoscopic computer simulator versus usage of box trainer for endoscopic surgery training of novices.
abstract: OBJECTIVE
  Teaching of laparoscopic skills is a challenge in surgical training programs. Because of the highly technical nature and the steep learning curve, students and residents must learn laparoscopic skills before performing them in the operating room. To improve efficiency of learning and patient safety, research in simulation is essential. Two types of simulators currently in use include virtual reality and box trainers. Our study examined which simulator technique was most effective in teaching novice trainees laparoscopic techniques.
  
  
  METHODS
  This is a prospective, randomized, blinded, controlled trial that enrolled fourth-year medical students and surgical interns to participate in a supervised 6-month laparoscopic training program with either computer simulators or box trainers. Subjects were randomized and trained on appropriate laparoscopic camera skills, instrument handling, object positioning, dissection, ligation, suturing, and knot tying. Students within one group were not allowed to practice, learn or train on the opposing trainers. At time points 0, 2, and 6 months all subjects completed a series of laparoscopic exercises in a live porcine model, which were captured on DVD and scored by blinded expert investigators.
  
  
  RESULTS
  Scores improved overall from the pretest to subsequent tests after training with no difference between the virtual reality and box simulator groups. In the medical students specifically, there was overall improvement, and improvement in the needle-transfer and knot-tying skills specifically, with no difference between the box simulator and virtual reality groups. For the interns, both groups showed significant overall improvement with no difference between the virtual reality and box simulator groups or on individual skills.
  
  
  CONCLUSIONS
  We conclude that laparoscopic simulator training improves surgical skills in novice trainees. We found both the box trainers and the virtual reality simulators are equally effective means of teaching laparoscopic skills to novice learners.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. dld5b@hotmail.com
authors.forename: Diana L
authors.initials: DL
authors.lastname: Diesen
authors.forename: Loretta
authors.initials: L
authors.lastname: Erhunmwunsee
authors.forename: Kyla M
authors.initials: KM
authors.lastname: Bennett
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
authors.forename: Basil
authors.initials: B
authors.lastname: Yurcisin
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.forename: Philip A
authors.initials: PA
authors.lastname: Omotosho
authors.forename: Alexander
authors.initials: A
authors.lastname: Perez
authors.forename: Aurora
authors.initials: A
authors.lastname: Pryor
mesh_terms: D000818:Animals; D002983:Clinical Competence; D003198:Computer Simulation; D016001:Confidence Intervals; D003479:Curriculum; D004195:Disease Models, Animal; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D008297:Male; D008953:Models, Anatomic; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016037:Single-Blind Method; D013337:Students, Medical; D013552:Swine; D013647:Task Performance and Analysis; D013997:Time Factors; D055815:Young Adult