Skip to main content
SpringerLink
Log in

Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers.

Methods

Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1-4). They were asked to perform the PC or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared.

Results

There were no significant differences between the FLS and VBLaST© scores for either the PC or the ligating loop task. Experts’ scores were significantly higher than the scores for novices on both trainers.

Conclusion

This study showed that the subjects’ performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Although concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Maithel S, Sierra R, Korndorffer J, Neumann P, Dawson S, Callery M, Jones D, Scott D (2006) Construct and face validity of MIST-VR, Endotower, and CELTS: are we ready for skills assessment using simulators? Surg Endosc 20(1):104–112

    Article  CAS  PubMed  Google Scholar 

  2. Cao C, MacKenzie C (1997) “Direct, 2-D vs. 3-D endoscopic viewing & surgical task performance,” A Symposium on Evolving Technologies: Surgeons’ Performance of Surgical Tasks. J. Sport and Exercise Psychology 19

  3. Adrales GL, Chu U, Witzke D, Donnelly M, Hoskins JD (2003) Evaluating minimally invasive surgery training using low-cost mechanical simulations. Surg Endosc 17:580–585

    Article  CAS  PubMed  Google Scholar 

  4. Peters J, Fried G, Swanstrom L, Soper N, Sillin L, Schirmer B, Hoffman K, Sages FLS Committee (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135(1):21–27

    Article  PubMed  Google Scholar 

  5. Powers T, Murayama K, Toyama M, Murphy S, Denham E, Derossis A, Joehl R (2002) House staff performance is improved by participation in a laparoscopic skills curriculum. Am J Surg 184:626–629

    Article  PubMed  Google Scholar 

  6. Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) valuating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17(6):964–967

    Article  CAS  PubMed  Google Scholar 

  7. Fried GM (2008) FLS assessment of competency using simulated laparoscopic tasks. J Gastrointest Surg 12(2):210–212

    Article  PubMed  Google Scholar 

  8. Botden S, Buzink S, Schijven MJJ (2007) Augmented versus virtual reality laparoscopic simulation: what is the difference? World J Surg 31(4):764–772

    Article  PubMed Central  PubMed  Google Scholar 

  9. Sankaranarayanan G, Lin H, Arikatla V, Mulcare M, Zhang L, Derevianko A, Lim R, Fobert D, Cao C, Schwaitzberg S, Jones D, De S (2010) Preliminary face and construct validation study of a virtual basic laparoscopic skill trainer. J Laparoendosc Adv Surg Tech A 20(2):153–157

    Article  PubMed Central  PubMed  Google Scholar 

  10. Chellali A, Dumas C, Milleville-Pennel I (2012) Haptic communication to support biopsy procedures learning in virtual environments. Presence Teleop Virtual Environ 21(4):470–489

    Article  Google Scholar 

  11. Grantcharov T, Rosenberg J, Pahle E, Fench P (2001) Virtual reality computer simulation. Surg Endosc 15:242–244

    Article  CAS  PubMed  Google Scholar 

  12. Reich O, Noll M, Gratzke C, Bachmann A, Waidelich R, Seitz M, Schlenker B, Baumgartner R, Hofstetter A, Stief C (2006) High-level virtual reality simulator for endourologic procedures of lower urinary tract. Urology 67(6):1144–1148

    Article  PubMed  Google Scholar 

  13. Dang T, Annaswamy T, Srinivasan M (2001) Development and evaluation of an epidural injection simulator with force feedback for medical training. Stud Health Technol Inform 81:97–102

    CAS  PubMed  Google Scholar 

  14. Panait L, Akkary E, Bell R, Roberts K, Dudrick S, Duffy A (2009) The role of haptic feedback in laparoscopic simulation training. J Surg Res 156(2):312–316

    Article  PubMed  Google Scholar 

  15. Seymour NE, Gallagher AG, Roman SA, O’Bri BMK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance results of a randomized, double-blinded study. Ann Surg 236(4):458–464

    Article  PubMed Central  PubMed  Google Scholar 

  16. Ström P, Hedman L, Särnå L, Kjellin A, Wredmark T, Felländer-Tsai L (2006) Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents. Surg Endosc 20(9):1383–1388

    Article  PubMed  Google Scholar 

  17. Aggarwal R, Grantcharov T, Eriksen J, Blirup D, Kristiansen V, Funch-Jensen P, Darzi A (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244(2):310–314

    Article  PubMed Central  PubMed  Google Scholar 

  18. “Epona Medical | LAP-X”. http://www.lapx.eu/en/lapx.html. Accessed 26 June 2013

  19. Zhang A, Hünerbein M, Dai Y, Schlag P, Beller S (2008) Construct validity testing of a laparoscopic surgery simulator (Lap Mentor): evaluation of surgical skill with a virtual laparoscopic training simulator. Surg Endosc 22(6):1440–1444

    Article  PubMed  Google Scholar 

  20. Iwata N, Fujiwara M, Kodera Y, Tanaka C, Ohashi N, Nakayama G, Koike M, Nakao A (2011) Construct validity of the LapVR virtual-reality surgical simulator. Surg Endosc 25(2):423–428

    Article  PubMed  Google Scholar 

  21. Ayodeji ID, Schijven M, Jakimowicz J, Greve JW (2007) Face validation of the Simbionix LAP Mentor virtual reality training module and its applicability in the surgical curriculum. Surg Endosc 21(9):1641–1649

    Article  CAS  PubMed  Google Scholar 

  22. Salkini MW, Doarn CR, Kiehl N, Broderick TJ, Donovan JF, Gaitonde K (2010) The role of haptic feedback in laparoscopic training using the LapMentor II. J Endourol 24(1):99–102

    Article  PubMed  Google Scholar 

  23. Gallagher AG, O’Sullivan GC (2012) Human factors in acquiring medical skills; learning and skill acquisition in surgery. In: Gallagher A, O’Sullivan G (eds) Fundamentals of surgical simulation. Springer-Verlag, London, pp 98–118

    Chapter  Google Scholar 

  24. Arikatla V, Sankaranarayanan G, Ahn W, Chellali A, De S, Cao C, Hwabejire J, DeMoya M, Schwaitzberg S, Jones D (2013) Face and construct validation of a virtual peg transfer simulator. Surg Endosc 27(5):1721–1729

    Article  PubMed Central  PubMed  Google Scholar 

  25. Zhang L, Sankaranarayanan G, Arikatla V, Ahn W, Grosdemouge C, Rideout J, Epstein S, De S, Schwaitzberg S, Jones D, Cao CGL (2013) Characterizing the learning curve of the VBLaST-PT© (Virtual Basic Laparoscopic Skill Trainer). Surg Endosc 27(10):3603–3615

    Article  PubMed Central  PubMed  Google Scholar 

  26. Flinn J, Wood D, Cao C (2013) Technology-based procedure for automatic and objective error measurement in FLS pattern cutting task. In: Proceedings of the Annual Meeting of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES 2013), Baltimore, MD

  27. ISO (1999) Human-centred design processes for interactive systems (ISO 13407:1999). International Organization for Standardization, Geneva

    Google Scholar 

Download references

Acknowledgments

This project was supported by National Institutes of Health (NIH) Grant NIBIB R01 EB010037-01. This research was conducted in collaboration with the SAGES FLS Committee.

Disclosures

Dr. Steven, D. Schwaitzberg is a consultant for Stryker and Olympus and member of the advisory board for NeatStitch, AcuityBio, MITI, Cambridge Endo, and Surgiquest. Jeff Flinn and Drs. Amine Chellali, Woojin Ahn, Ganesh Sankaranarayanan, Daniel B. Jones, Suvranu De, and Caroline, G.L. Cao have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA

    A. Chellali & S. D. Schwaitzberg

  2. Department of Computing Engineering, University of Evry, IBISC Laboratory, Evry, France

    A. Chellali

  3. Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, USA

    W. Ahn, G. Sankaranarayanan & Suvranu De

  4. Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, 207 Russ Engineering Center, 3640 Colonel Glenn Hwy, Dayton, OH, USA

    J. T. Flinn & C. G. L. Cao

  5. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    D. B. Jones

Authors
  1. A. Chellali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Sankaranarayanan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. T. Flinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. D. Schwaitzberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. B. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Suvranu De
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. G. L. Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. G. L. Cao.

Additional information

Presented as an oral presentation at the SAGES 2014 annual meeting.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chellali, A., Ahn, W., Sankaranarayanan, G. et al. Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers. Surg Endosc 29, 815–821 (2015). https://doi.org/10.1007/s00464-014-3764-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3764-7

Keywords

Search

Navigation