title: Commercial video laparoscopic trainers versus less expensive, simple laparoscopic trainers: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Advancements in laparoscopic surgical simulation have led to technologically sophisticated but generally more costly surgical trainers. Given that higher costs can limit training institutions, an exploration of cost-effective alternatives is a worthwhile endeavor. We compared commercial video laparoscopic trainers and less expensive simple laparoscopic trainers to evaluate how they differ in facilitating the acquisition of laparoscopic skills in surgical trainees, as measured by laparoscopic task completion time.
  
  
  METHODS
  We performed a comprehensive, systematic search of the literature, which yielded 1,091 citations after excluding duplicates. Ten articles were fully reviewed and 5 were included in the final analysis. Articles were reviewed to ensure that a comparison of video and simple laparoscopic trainers was present and laparoscopic tasks were examined. Quality assessment of studies was completed using a comprehensive checklist. We examined continuous data with calculation of the standardized mean difference. Performance times were pooled using a random effects model and the chi-square test for heterogeneity. Meta-analysis was done to compare post-training performance times between video and simple laparoscopic trainers for the 2 laparoscopic tasks of suturing and object transfer.
  
  
  RESULTS
  We found no statistically significant difference in task completion time for video and simple laparoscopic trainers. Meta-analysis of the 7 laparoscopic tasks assessed by others favored video over simple laparoscopic trainers but this was not statistically significant (standardized mean difference -1.82, 95% CI -0.61-0.02, p = 0.07).
  
  
  CONCLUSIONS
  Video and simple laparoscopic trainers are equally proficient for facilitating the acquisition of laparoscopic skills, suggesting that simple laparoscopic trainers may be a cost-effective alternative.
authors.affiliation: Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Nguyen
authors.forename: Luis H
authors.initials: LH
authors.lastname: Braga
authors.forename: Jen
authors.initials: J
authors.lastname: Hoogenes
authors.forename: Edward D
authors.initials: ED
authors.lastname: Matsumoto
mesh_terms: D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000191:economics / Q000193:education* / Q000379:methods; D008297:Male; D016032:Randomized Controlled Trials as Topic; D013520:Urologic Surgical Procedures / Q000193:education*; D020535:Video-Assisted Surgery / Q000191:economics / Q000193:education*
keywords: PGY; RCT; SLT; SMD; VLT; clinical competence; cost-benefit analysis; education, medical; laparoscopy; postgraduate year; randomized, controlled trial; simple laparoscopic trainer; standardized mean difference; urology; video laparoscopic trainer