Laparoscopy
A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition

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Abstract

Objectives: To evaluate virtual reality as a laparoscopic training device in helping surgeons to automate to the “fulcrum effect” by comparing it to time-matched training programs using randomly alternating images (ie, y-axis inverted and normal laparoscopic) and normal laparoscopic viewing conditions.

Methods: Twenty-four participants (16 females and 8 males), were randomly assigned to minimally invasive surgery virtual reality (MIST VR), randomly alternating (between y-axis inverted and normal laparoscopic images), and normal laparoscopic imaging condition. Participants were requested to perform a 2-minute laparoscopic cutting task before and after training.

Results: In the test trial participants who trained on the MIST VR performed significantly better than those in the normal laparoscopic and randomly alternating imaging conditions.

Conclusion: The results show that virtual reality training may provide faster skill acquisition with particular reference to automation of the fulcrum effect. MIST VR provides a new way of training laparoscopic psychomotor surgical skills.

Section snippets

Subjects

Twenty-four subjects (16 female, 8 male) with no previous experience of laparoscopic surgery were recruited to the study. The mean age was 23.04 years (range 19 to 48). Sixteen of the participants reported corrected vision and 3 stated a preference for their left hand.

Apparatus

The training programme was divided into 3 conditions. In condition 1 subjects completed 6 simulated training tasks on MIST VR. The MIST VR system comprises a standard 200 MHz Pentium PC with 32 Mb RAM, linked to a jig containing

Results

Figure 2 shows the number of correct incisions made by the three groups before training. The Mann-Whitney U test was used to test for differences between the groups. There were no significant differences found between the three training conditions on the laparoscopic cutting task before training.

Figure 3 shows performance by the three groups on the laparoscopic cutting task after training. Participants who had trained on MIST VR (condition 1) made a greater number of correct incisions than

Comments

The results of this study indicate that the form of training undertaken has a significant effect on subsequent performance under normal laparoscopic imaging conditions. Initially, there was no significant difference between the three training groups. This suggests that the participants’ performance on the test trial was a result of the training condition to which they were allocated.

The study reported here is a follow-up to the study of Jordan et al8 that demonstrated that randomly alternating

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