title: Can virtual reality simulators be a certification tool for bariatric surgeons?
abstract: BACKGROUND
  Construct validity of virtual laparoscopic simulators for basic laparoscopic skills has been proposed; however, it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. This study tested the ability of the Lap Mentor simulator to recognize the experience in advanced laparoscopic procedures and to assess its role in the certification of bariatric surgeons.
  
  
  METHODS
  Twenty surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery. The general group included 10 general surgeons performing between 75 and 100 nonbariatric laparoscopic procedures. The bariatric group included 10 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the simulator in one basic task (task 1: eye-hand coordination) and in two tasks of the gastric bypass module (task 2: creation of the gastric pouch; task 3: gastrojejunal anastomosis).
  
  
  RESULTS
  Comparing the groups, no significant differences were found in task 1. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (21 vs. 48 cm(3)), in the percentage of fundus included in the pouch (8.4 vs. 29.4 %), in the complete dissection at the angle of His (10 vs. 3), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies.
  
  
  CONCLUSIONS
  The Lap Mentor may be proposed as a certification tool for bariatric surgeons because it also recognizes their specific skills in the technical details of the procedure that affect long-term results. Furthermore, the possibility of analyzing the performance in detail can help define areas where the surgeon is lacking. These findings indicate a potential role of the Lap Mentor in tailoring the training to maximize improvement.
authors.affiliation: Department of Surgical Sciences, Policlinico "Umberto I", "Sapienza" - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy, domenico.giannotti@uniroma1.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Giannotti
authors.forename: Gregorio
authors.initials: G
authors.lastname: Patrizi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casella
authors.forename: Giorgio
authors.initials: G
authors.lastname: Di Rocco
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marchetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Frezzotti
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Bernieri
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vestri
authors.forename: Adriano
authors.initials: A
authors.lastname: Redler
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000193:education; D050110:Bariatric Surgery / Q000193:education*; D002568:Certification; D002983:Clinical Competence; D003198:Computer Simulation; D004210:Dissection / Q000193:education; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000193:education; D008297:Male; D008875:Middle Aged; D011597:Psychomotor Performance; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D063367:Virtual Reality Exposure Therapy / Q000193:education* / Q000592:standards