title: Single-session baseline virtual reality simulator scores predict technical performance for laparoscopic colectomy: a study in the swine model.
abstract: OBJECTIVE
  Virtual reality (VR) simulation helps reducing the learning curve of laparoscopic colectomy. Moreover, it may be used to ascertain surgeons' pretraining skills. It was aimed to establish predictive validity of specific parameters gathered during VR simulation training on sigmoid colectomy and whether simulator parameters correlate with technical performance during the same operation in a swine model.
  
  
  METHODS
  Surgeons novice to laparoscopic colectomy underwent a single VR simulation session on sigmoid colectomy. Next, all participants performed a laparoscopic sigmoidectomy in the swine. Operations were recorded. Performance evaluation was conducted by 2 board-certified colorectal surgeons blinded to surgeons' simulator scores using an instrument specific to laparoscopic colectomy. For each participant, a mean score of specific skills was calculated. Linear regression analysis was used to identify simulator parameters that were best related to the score. The stepwise method was used to select parameters. The magnitude of the regression model was measured by the coefficient of determination (R(2)) value.
  
  
  METHODS
  The University of Sao Paulo Medical Center is a high-volume, public practice, university-affiliated hospital.
  
  
  METHODS
  A total of 14 first-year residents in digestive tract surgery were included.
  
  
  RESULTS
  Analysis of variance demonstrated that the regression model was significant (p = 0.0001), and an association between simulation scores and specific skills was confirmed. The R(2) value was 99%. The VR simulator parameters that strongly correlated with specific skills during laparoscopic colectomy in the swine were safe use of electrosurgery/energy device and safety of medial-to-lateral dissection.
  
  
  CONCLUSIONS
  A single VR simulation session for novice surgeons in the sigmoid colectomy module generates baseline scores that highly correlated with performance of specific skills during a laparoscopic colectomy in the swine. This information may be useful in an attempt to tailor VR simulator practice according to a surgeon's needs.
authors.affiliation: Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Division of Colorectal Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil. Electronic address: sergioaraujo@colorretal.com.br.
authors.forename: Sergio Eduardo Alonso
authors.initials: SE
authors.lastname: Araujo
authors.affiliation: Division of Colorectal Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil.
authors.forename: Victor E
authors.initials: VE
authors.lastname: Seid
authors.affiliation: Division of Colorectal Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil.
authors.forename: Alexandre B
authors.initials: AB
authors.lastname: Bertoncini
authors.affiliation: Division of Colorectal Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil.
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Horcel
authors.affiliation: Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Division of Colorectal Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil.
authors.forename: Sergio C
authors.initials: SC
authors.lastname: Nahas
authors.affiliation: Department of Gastroenterology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Division of Digestive Surgery, University of Sao Paulo Medical Center, Sao Paulo, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D000818:Animals; D002983:Clinical Competence; D003082:Colectomy / Q000193:education*; D003194:Computer-Assisted Instruction; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000193:education*; D023421:Models, Animal; D013552:Swine; D014584:User-Computer Interface
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; clinical skills; colectomy; colonic neoplasms; credentialing; education; laparoscopy