title: Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis.
abstract: BACKGROUND
  Laparoscopic surgery requires a different and sometimes more complex skill set than does open surgery. Shortened working hours, less training times, and patient safety issues necessitates that these skills need to be acquired outside the operating room. Virtual reality simulation in laparoscopic surgery is a growing field, and many studies have been published to determine its effectiveness.
  
  
  OBJECTIVE
  This systematic review and meta-analysis aims to evaluate virtual reality simulation in laparoscopic abdominal surgery in comparison to other simulation models and to no training.
  
  
  METHODS
  A systematic literature search was carried out until January 2014 in full adherence to PRISMA guidelines. All randomised controlled studies comparing virtual reality training to other models of training or to no training were included. Only studies utilizing objective and validated assessment tools were included.
  
  
  RESULTS
  Thirty one randomised controlled trials that compare virtual reality training to other models of training or to no training were included. The results of the meta-analysis showed that virtual reality simulation is significantly more effective than video trainers, and at least as good as box trainers.
  
  
  CONCLUSIONS
  The use of Proficiency-based VR training, under supervision with prompt instructions and feedback, and the use of haptic feedback, has proven to be the most effective way of delivering the virtual reality training. The incorporation of virtual reality training into surgical training curricula is now necessary. A unified platform of training needs to be established. Further studies to assess the impact on patient outcomes and on hospital costs are necessary. (PROSPERO Registration number: CRD42014010030).
authors.affiliation: ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK. Electronic address: Medhat.alaker@nhs.net.
authors.forename: Medhat
authors.initials: M
authors.lastname: Alaker
authors.affiliation: ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK.
authors.forename: Greg R
authors.initials: GR
authors.lastname: Wynn
authors.affiliation: ICENI Centre, Colchester General Hospital, Department of Colorectal Surgery, Colchester CO 45JL, UK.
authors.forename: Tan
authors.initials: T
authors.lastname: Arulampalam
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D016032:Randomized Controlled Trials as Topic; D014584:User-Computer Interface
keywords: Laparoscopic surgery; Surgical training; Virtual reality simulation