title: Virtual reality simulator training of laparoscopic cholecystectomies - a systematic review.
abstract: OBJECTIVE
  Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies.
  
  
  METHODS
  From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included.
  
  
  RESULTS
  The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000.
  
  
  CONCLUSIONS
  Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.
authors.affiliation: Finnish Office for Health Technology Assessment, National Institute of Health and Welfare, Helsinki, Finland. tuija.ikonen@thl.fi
authors.forename: T S
authors.initials: TS
authors.lastname: Ikonen
authors.forename: T
authors.initials: T
authors.lastname: Antikainen
authors.forename: M
authors.initials: M
authors.lastname: Silvennoinen
authors.forename: J
authors.initials: J
authors.lastname: Isojärvi
authors.forename: E
authors.initials: E
authors.lastname: Mäkinen
authors.forename: T M
authors.initials: TM
authors.lastname: Scheinin
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000193:education*; D002983:Clinical Competence; D003479:Curriculum; D006801:Humans; D013663:Teaching / Q000379:methods*; D014584:User-Computer Interface