title: A comparison of 2 ex vivo training curricula for advanced laparoscopic skills: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness and cost of 2 ex vivo training curricula for laparoscopic suturing.
  
  
  BACKGROUND
  Although simulators have been developed to teach laparoscopic suturing, a barrier to their wide implementation in training programs is a lack of knowledge regarding their relative training benefit and their associated cost.
  
  
  METHODS
  This prospective single-blinded randomized trial allocated 24 surgical residents to train to proficiency using either a virtual reality (VR) simulator or box trainer. All residents then placed intracorporeal laparoscopic stitches during a Nissen fundoplication on a patient. The operating room (OR) cases were video-recorded and technical proficiency was assessed using 2 validated tools. OR performance of both groups was compared to that of conventionally trained residents and to fellowship-trained surgeons. A cost analysis of box training, VR training, and conventional residency training across Canadian surgical programs was performed.
  
  
  RESULTS
  After ex vivo training, no significant differences in laparoscopic suturing in the OR were found between the 2 groups with respect to time (P = 0.74)-global rating score (P = 0.65) or checklist score (P = 0.97). It took conventionally trained residents 6 practice attempts in the OR to achieve the technical proficiency of the ex vivo trained groups (P = 0.83). VR training was more efficient than box training (transfer effectiveness ratio of 2.31 vs 1.13). The annual cost of training 5 residents on the FLS trainer box was $11,975.00, on the VR simulator was $77,500.00, and conventional residency training was $17,380.00. Over 5 years, box training was the most cost-effective option for all programs, and VR training was more cost-effective for programs with more 10 residents.
  
  
  CONCLUSIONS
  Training on either a VR simulator or on a box trainer significantly decreased the learning curve necessary to learn laparoscopic suturing. VR training, however, is the more efficient training modality, whereas box training the more cost-effective option.
authors.affiliation: Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Neil
authors.initials: N
authors.lastname: Orzech
authors.forename: Vanessa N
authors.initials: VN
authors.lastname: Palter
authors.forename: Richard K
authors.initials: RK
authors.lastname: Reznick
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Teodor P
authors.initials: TP
authors.lastname: Grantcharov
mesh_terms: D002170:Canada; D002983:Clinical Competence; D003198:Computer Simulation; D003365:Costs and Cost Analysis; D003479:Curriculum; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D011446:Prospective Studies; D016037:Single-Blind Method; D013536:Suture Techniques / Q000193:education*; D013647:Task Performance and Analysis; D014584:User-Computer Interface