title: Virtual reality training followed by box training improves the laparoscopic skills of novice surgeons.
abstract: BACKGROUND
  The detailed influence of virtual reality training (VRT) and box training (BT) on laparoscopic performance is unknown; we aimed to determine the optimal order of imparting these training programs.
  
  
  METHODS
  This randomized controlled trial involved two groups, each with 20 participants without prior laparoscopic surgical experience: A BT-VRT group (60 min BT followed by 60 min VRT) and a VRT-BT group (60 min VRT followed by 60 min BT). We objectively assessed the laparoscopic skills with a motion-analysis system (Hiroshima University Endoscopic Surgical Assessment Device: HUESAD), which reliably assesses surgical dexterity. Skill assessment was performed before and after the training session.
  
  
  RESULTS
  No inter-group differences were identified in the study measures at the pre-training assessment. In both groups, the performance on all tasks was significantly better at the post-training assessment than at the pre-training assessment. However, the outcome of the tests using the HUESAD was significantly better in the VRT-BT group than in the BT-VRT group at the post-training assessment.
  
  
  CONCLUSIONS
  VRT followed by BT effectively improves the dexterity of novice surgeons during initial laparoscopic (combination) training.
authors.affiliation: Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sumitani
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Egi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Minoru
authors.initials: M
authors.lastname: Hattori
authors.forename: Masanori
authors.initials: M
authors.lastname: Yoshimitsu
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawahara
authors.forename: Masazumi
authors.initials: M
authors.lastname: Okajima
authors.forename: Hideki
authors.initials: H
authors.lastname: Ohdan
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000592:standards*; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D014584:User-Computer Interface