Development of a virtual reality training curriculum for laparoscopic cholecystectomy

Aggarwal, Rajesh; Crochet, Patrice; Dias, André Roncon; Misra, Aditya Prakash; Ziprin, Paul; Darzi, Ara

doi:10.1002/bjs.6679

Cited by 208 publications

(167 citation statements)

References 19 publications

(24 reference statements)

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“…Two-handed grasp and cut (transfer) task Hypothesis 3 predicted that the GT group would exhibit superior performance and gaze control on a two-handed transfer test than the DL group, despite both groups exclusively learning on a simpler one-handed task. Generalisation of skills is a vital component of training during the early learning curve phase if video box trainers are to be beneficial for laparoscopic training curricula [14,20,21,24,25]. Both the GT and DL groups improved their completion time in the transfer task from baseline to retention by 46 and 38 %, respectively (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…2). Previous research has shown that similar two-handed grasping and clipping surgical tasks have been able to differentiate performance between novices and experts; have revealed appropriate construct validity and learning curve progression in novices; and emulate the technical precision required to clip and cut a cystic duct during a laparoscopic cholecystectomy [20,21]. Participants were instructed to complete both tasks as quickly and as accurately as possible.…”

Section: Apparatus and Taskmentioning

confidence: 99%

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Gaze training improves the retention and transfer of laparoscopic technical skills in novices

et al. 2013

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Background Gaze training is an effective way of training basic laparoscopic skills, resulting in faster acquisition periods and more robust subsequent performance under pressure. The current study is a randomized control trial which examines whether the performance benefits of gaze training stand the test of time (delayed retention) and transfer to more complex skills. Methods Thirty-six medical students were trained to proficiency (50 trials) on a one-handed laparoscopic task (picking and dropping balls) in either a discovery learning (DL) or gaze training (GT) group. Both groups performed the one-handed task in baseline, retention and delayed retention (1 month) tests. They also performed baseline, retention and delayed retention tests of a two-handed task (grasping and cutting). Performance (completion time) and gaze control (target locking) were assessed throughout. Results For the one-handed task, the GT group displayed superior performance at retention (p \ .001), underpinned by more expert-like gaze control (p \ .05). The GT group also displayed superior performance in the one-handed task at delayed retention (p \ .005), underpinned by more expert-like gaze control strategies (p \ .001). Although the DL group's performance fell to 84 % of performance at retention, the GT group maintained performance at 100 % of retention. There were no differences between the groups for the two-handed task at retention (p = .140); however, at delayed retention, the GT group outperformed the DL group (p \ .005) and displayed more expert-like gaze control (p \ .001). Conclusions Novices trained to adopt an expert-like gaze control strategy were able to attain higher levels of performance more quickly than novices who learned by discovery alone. Furthermore, these skills were more durable over time and were transferable to more complex skills. Gaze training is a beneficial intervention to aid the acquisition of the basic motor skills required for laparoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Apparatus and Taskmentioning

confidence: 99%

Gaze training improves the retention and transfer of laparoscopic technical skills in novices

et al. 2013

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“…In this study the following three used for assessing surgical performance: (i) number These metrics have been shown to reflect surgical proficiency [16].…”

Section: Evaluation Of Cholecystectomy Performed On Vr Simulatormentioning

confidence: 99%

“Take-home” box trainers are an effective alternative to virtual reality simulators

Yiasemidou

Siqueira

Tomlinson

et al. 2017

Journal of Surgical Research

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Background: Practice on Virtual Reality simulators (VRS) have been shown to improve surgical performance. However, VRS are expensive and usually housed in surgical skills centres that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers are inexpensive and can be used anywhere at anytime. This study assesses "take-home" Box Trainers (BT) as an alternative to VRS.Methods: After baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT) 25 surgical trainees were randomised to two groups. Trainees were asked to practice 3 basic laparoscopic tasks for 6 weeks (BT group using a "take-home" box trainer; VR group using VRS in clinical skills centres). After the practice period all performed two LC, one on a VRS and one on a BT; (i.e. post-training assessment). VRS provided metrics (total time (TT), number of movements (NOM) instrument tip path length (PL)) and expert video assessment of cholecystectomy in a BT (GOALS score) were recorded. Performance during pre-and post-training assessment was compared.Results: The BT group showed a significant improvement for all VRS metrics (p=0.008) and the efficiency category of GOALS score (p=0.03). Only TT improved in the VRS group and none of the GOALS categories demonstrated a statistically significant improvement after training.

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“…For all considered tasks, the most prominent motion efficiency metrics are time, path length and economy of movements [24,30,31,34]. They are especially important in the tasks which involve touching or grasping objects on the scenario, both with one or two instruments; and that require bi-manual coordination.…”

Section: Clinical Definition Of Metricsmentioning

confidence: 99%

“…However, depending on the nature and difficultness of the task, these metrics might not always show significant differences [57]. For these same tasks, a number of studies have shown that speed of movements can be a differentiating aspect [29,31,48]. This may partly be due to the difficulty of determining an optimal path, which in any case will depend on the task's goal.…”

Section: Clinical Definition Of Metricsmentioning

confidence: 99%

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

García

Sánchez-González

Lamata

et al. 2011

Journal of Surgical Research

126

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Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentortrainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons' psychomotor skills. Ongoing development of tracking systems and software Solutions has allowed for the expansión of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentáis of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as 1 To whom correspondence and reprint requests should be addressed at Bioengineering and Telemedicine Centre (GBT), ETSI Telecomunicación, Universidad Politécnica de Madrid (UPM). Avda Complutense, 30, 28040, Madrid, Spain. E-mail: ioropesa@gbt.tfo. upm.es. well as optimize their already overloaded training schedules.

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Development of a virtual reality training curriculum for laparoscopic cholecystectomy

Abstract: This study shows that it is possible to define and develop a whole-procedure VR training curriculum for laparoscopic cholecystectomy using structured scientific methodology.

Cited by 208 publications

References 19 publications

Gaze training improves the retention and transfer of laparoscopic technical skills in novices

Gaze training improves the retention and transfer of laparoscopic technical skills in novices

“Take-home” box trainers are an effective alternative to virtual reality simulators

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

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