title: Mapping the maze of minimally invasive surgery simulators.
abstract: BACKGROUND
  Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed.
  
  
  METHODS
  A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods.
  
  
  RESULTS
  Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS.
  
  
  CONCLUSIONS
  No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
authors.affiliation: Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands. p.vanempel@vumc.nl
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: van Empel
authors.forename: Willem M
authors.initials: WM
authors.lastname: van der Veer
authors.forename: Lennart B
authors.initials: LB
authors.lastname: van Rijssen
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
authors.forename: H Jaap
authors.initials: HJ
authors.lastname: Bonjer
authors.forename: Wilhelmus J
authors.initials: WJ
authors.lastname: Meijerink
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D059032:Learning Curve; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D011598:Psychoneuroimmunology; D013647:Task Performance and Analysis; D014584:User-Computer Interface