Consensus views on the optimum training curriculum for advanced minimally invasive surgery: A delphi study.

Introduction: There has been a wide uptake in the use of Minimal Invasive Surgery (MIS) globally across different surgical specialties. Whilst evidence exists for a structured training curriculum for basic laparoscopic surgery, there is little agreement on a complete framework for an advanced MIS training curriculum, defining the essential elements of the curriculum including the optimal assessment methods. The aim of this study is to obtain a consensus on the essential elements of a training curriculum for advanced MIS.

Face validation of a portable ergonomic laparoscopy skills simulator for single-incision laparoscopic surgery training.

In recent years, many efforts have been made to reduce the trauma of surgical access further by the use of single-incision laparoscopic surgery (SILS). The Ergo-Lap (ergonomic laparoscopic) simulator was taken to the 20th International Congress of the European Association for Endoscopic Surgery (EAES) in 2012 in Brussels, Belgium. During the congress, the simulator was assessed by 13 general surgeons with different SILS experience using a standardized questionnaire to determine the usability of the Ergo-Lap simulator training for basic SILS skills.

Face, content, and construct validity of a novel portable ergonomic simulator for basic laparoscopic skills.

Objective: Laparoscopic skills can be improved effectively through laparoscopic simulation. The purpose of this study was to verify the face and content validity of a new portable Ergonomic Laparoscopic Skills simulator (Ergo-Lap simulator) and assess the construct validity of the Ergo-Lap simulator in 4 basic skills tasks.

Design: Four tasks were evaluated: 2 different translocation exercises (a basic bimanual exercise and a challenging single-handed exercise), an exercise involving tissue manipulation under tension, and a needle-handling exercise.

Assessment of basic laparoscopic skills on virtual reality simulator or box trainer.

Introduction: We investigated whether the peg transfer task is interchangeable between a VR simulator and a box trainer. Our research questions: (1) Are scores of the box trainer interchangeable with the virtual equivalent of the exercise; (2) does training on the box affect performance on the VR simulator and vice versa; and (3) which system is preferred?

Methods: Experienced laparoscopists and medical interns were randomly assigned to one of two groups (V or B). They performed eight repetitions of the peg transfer task (4 on each simulator system) following a crossover study design.

Laparoscopic Surgical Skills programme: preliminary evaluation of Grade I Level 1 courses by trainees.

Introduction: New training models are needed to maintain safety and quality of surgical performance. A simulated setting using virtual reality, synthetic, and/or organic models should precede traditional supervised training in the operating room.

Aim: The aim of the paper is to describe the Laparoscopic Surgical Skills (LSS) programme and to provide information about preliminary evaluation of Grade I Level 1 courses, including overall quality, applicability of the course content in practice and the balance between theory and hands-on training modules, by participating trainees.

Procedural virtual reality simulation in minimally invasive surgery.

Background: Simulation of procedural tasks has the potential to bridge the gap between basic skills training outside the operating room (OR) and performance of complex surgical tasks in the OR. This paper provides an overview of procedural virtual reality (VR) simulation currently available on the market and presented in scientific literature for laparoscopy (LS), flexible gastrointestinal endoscopy (FGE), and endovascular surgery (EVS).

Methods: An online survey was sent to companies and research groups selling or developing procedural VR simulators, and a systematic search was done for scientific publications presenting or applying VR simulators to train or assess procedural skills in the PUBMED and SCOPUS databases.

Single versus multimodality training basic laparoscopic skills.

Introduction: Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality training of basic laparoscopic skills.

Methods: Thirty-six medical students without laparoscopic experience performed six training sessions of 45 min each, one per day, in which four different basic tasks were trained.

Criterion-based laparoscopic training reduces total training time.

Introduction: The benefits of criterion-based laparoscopic training over time-oriented training are unclear. The purpose of this study is to compare these types of training based on training outcome and time efficiency.

Methods: During four training sessions within 1 week (one session per day) 34 medical interns (no laparoscopic experience) practiced on two basic tasks on the Simbionix LAP Mentor virtual-reality (VR) simulator: 'clipping and grasping' and 'cutting'.

Visuo-spatial ability in colonoscopy simulator training.

Visuo-spatial ability is associated with a quality of performance in a variety of surgical and medical skills. However, visuo-spatial ability is typically assessed using Visualization tests only, which led to an incomplete understanding of the involvement of visuo-spatial ability in these skills. To remedy this situation, the current study investigated the role of a broad range of visuo-spatial factors in colonoscopy simulator training.

Influence of anatomic landmarks in the virtual environment on simulated angled laparoscope navigation.

Background: The aim of this study is to investigate the influence of the presence of anatomic landmarks on the performance of angled laparoscope navigation on the SimSurgery SEP simulator.

Methods: Twenty-eight experienced laparoscopic surgeons (familiar with 30° angled laparoscope, >100 basic laparoscopic procedures, >5 advanced laparoscopic procedures) and 23 novices (no laparoscopy experience) performed the Camera Navigation task in an abstract virtual environment (CN-box) and in a virtual representation of the lower abdomen (CN-abdomen). They also rated the realism and added value of the virtual environments on seven-point scales.

Do basic psychomotor skills transfer between different image-based procedures?

Background: Surgical techniques that draw from multiple types of image-based procedures (IBP) are increasing, such as Natural Orifice Transluminal Endoscopic Surgery, fusing laparoscopy and flexible endoscopy. However, little is known about the relation between psychomotor skills for performing different types of IBP. For example, do basic psychomotor colonoscopy and laparoscopy skills interact?

Methods: Following a cross-over study design, 29 naïve endoscopists were trained on the Simbionix GI Mentor and the SimSurgery SEP simulators.

Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool.

Background: Awareness of the relative high rate of adverse events in laparoscopic surgery created a need to safeguard quality and safety of performance better. Technological innovations, such as integrated operating room (OR) systems and checklists, have the potential to improve patient safety, OR efficiency, and surgical outcomes. This study was designed to investigate the influence of the integrated OR system and Pro/cheQ, a digital checklist tool, on the number and type of equipment- and instrument-related risk-sensitive events (RSE) during laparoscopic cholecystectomies.

Training of basic laparoscopy skills on SimSurgery SEP.

The aim of this study was to assess the performance curve for novices training in bimanual tissue manipulation and angled laparoscope navigation, and compare those performances with the performances of experienced laparoscopic surgeons. The Camera Navigation task with a 30 degrees angled laparoscope and the Place Arrow task of the new SimSurgery SEP virtual reality simulator were used. Fourteen medical trainees (no laparoscopy experience) performed four training sessions within one week, including 15 repetitions of each task in total.

Do absorption and realistic distraction influence performance of component task surgical procedure?

Background: Surgeons perform complex tasks while exposed to multiple distracting sources that may increase stress in the operating room (e.g., music, conversation, and unadapted use of sophisticated technologies).

ProMIS augmented reality training of laparoscopic procedures face validity.

Background: Conventional video trainers lack the ability to assess the trainee objectively, but offer modalities that are often missing in virtual reality simulation, such as realistic haptic feedback. The ProMIS augmented reality laparoscopic simulator retains the benefit of a traditional box trainer, by using original laparoscopic instruments and tactile tasks, but additionally generates objective measures of performance.

Methods: Fifty-five participants performed a "basic skills" and "suturing and knot-tying" task on ProMIS, after which they filled out a questionnaire regarding realism, haptics, and didactic value of the simulator, on a 5-point-Likert scale.

Camera navigation and tissue manipulation; are these laparoscopic skills related?

Background: It is a tacit assumption that clinically based expertise in laparoscopic tissue manipulation entails skilfulness in angled laparoscope navigation. The main objective of this study was to investigate the relation between these skills. To this end, face and construct validity had to be established for the place arrow (PA) and camera navigation (CN) tasks on the SimSurgery SEP.

The importance of haptic feedback in laparoscopic suturing training and the additive value of virtual reality simulation.

Introduction: Previous studies on the difference between physical, augmented and virtual reality (VR) simulation state that haptic feedback is an important feature in laparoscopic suturing simulation. Objective assessment is important to improve skills during training. This study focuses on the additive value of VR simulation for laparoscopic suturing training.

Expert and construct validity of the Simbionix GI Mentor II endoscopy simulator for colonoscopy.

Objectives: The main objectives of this study were to establish expert validity (a convincing realistic representation of colonoscopy according to experts) and construct validity (the ability to discriminate between different levels of expertise) of the Simbionix GI Mentor II virtual reality (VR) simulator for colonoscopy tasks, and to assess the didactic value of the simulator, as judged by experts.

Methods: Four groups were selected to perform one hand-eye coordination task (EndoBubble level 1) and two virtual colonoscopy simulations on the simulator; the levels were: novices (no endoscopy experience), intermediate experienced (<200 colonoscopies performed before), experienced (200-1,000 colonoscopies performed before), and experts (>1,000 colonoscopies performed before). All participants filled out a questionnaire about previous experience in flexible endoscopy and appreciation of the realism of the colonoscopy simulations.

Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator.

Background: Virtual reality (VR) is an emerging new modality for laparoscopic skills training; however, most simulators lack realistic haptic feedback. Augmented reality (AR) is a new laparoscopic simulation system offering a combination of physical objects and VR simulation. Laparoscopic instruments are used within an hybrid mannequin on tissue or objects while using video tracking.

Hand supports to assist toilet use among the elderly.

Improving the toilet environment holds promises for increasing the quality of life for elderly and disabled persons. This is one of the goals of the Friendly Rest Room (FRR) project. The study described in this article explored the preference and use of supports in the toilet environment during the entire toilet ritual.