title: Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator.
abstract: OBJECTIVE
  Surgical simulators are currently essential within any laparoscopic training program because they provide a low-stakes, reproducible and reliable environment to acquire basic skills. The purpose of this study is to determine the training learning curve based on different metrics corresponding to five tasks included in SINERGIA laparoscopic virtual reality simulator.
  
  
  METHODS
  Thirty medical students without surgical experience participated in the study. Five tasks of SINERGIA were included: Coordination, Navigation, Navigation and touch, Accurate grasping and Coordinated pulling. Each participant was trained in SINERGIA. This training consisted of eight sessions (R1-R8) of the five mentioned tasks and was carried out in two consecutive days with four sessions per day. A statistical analysis was made, and the results of R1, R4 and R8 were pair-wise compared with Wilcoxon signed-rank test. Significance is considered at P value <0.005.
  
  
  RESULTS
  In total, 84.38% of the metrics provided by SINERGIA and included in this study show significant differences when comparing R1 and R8. Metrics are mostly improved in the first session of training (75.00% when R1 and R4 are compared vs. 37.50% when R4 and R8 are compared). In tasks Coordination and Navigation and touch, all metrics are improved. On the other hand, Navigation just improves 60% of the analyzed metrics. Most learning curves show an improvement with better results in the fulfillment of the different tasks.
  
  
  CONCLUSIONS
  Learning curves of metrics that assess the basic psychomotor laparoscopic skills acquired in SINERGIA virtual reality simulator show a faster learning rate during the first part of the training. Nevertheless, eight repetitions of the tasks are not enough to acquire all psychomotor skills that can be trained in SINERGIA. Therefore, and based on these results together with previous works, SINERGIA could be used as training tool with a properly designed training program.
authors.affiliation: Bioengineering and Health Technology Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain. lfsanchez@ccmijesususon.com
authors.forename: L F
authors.initials: LF
authors.lastname: Sánchez-Peralta
authors.forename: F M
authors.initials: FM
authors.lastname: Sánchez-Margallo
authors.forename: J L
authors.initials: JL
authors.lastname: Moyano-Cuevas
authors.forename: J B
authors.initials: JB
authors.lastname: Pagador
authors.forename: S
authors.initials: S
authors.lastname: Enciso
authors.forename: E J
authors.initials: EJ
authors.lastname: Gómez-Aguilera
authors.forename: J
authors.initials: J
authors.lastname: Usón-Gargallo
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D059032:Learning Curve; D008297:Male; D011597:Psychomotor Performance; D013647:Task Performance and Analysis; D014584:User-Computer Interface