Mapping the Maze of Minimally Invasive Surgery Simulators

Abstract

Background: Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higherquality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. Methods: A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. Results: Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. Conclusions:No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.

Virtual Reality Versus Box Laparoscopic Simulators in Trainee Selection and Aptitude Testing

“…2 To ensure the validity of a simulation, a number of different techniques have been described [3][4][5] : (1) Construct validity tests to what extent the skill we are seeking to measure, is actually being measured. The use of simulation in surgical selection is also practiced; however, it is important that these tests are valid if they are to be adopted into an equitable system.…”

“…3,[6][7][8][9][10][11][12][13][14] On the basis of these measures of concurrent and construct validity, we aim to evaluate the appropriateness of high-fidelity and low-fidelity tasks in surgical selection. Two popular systems that have been well validated include the low-fidelity Fundamentals of Laparoscopic Surgery box trainer (FLS) and the high fidelity, Lapsim, virtual reality trainer.…”

Construct validity of eoSim – a low-cost and portable laparoscopic simulator

“…There is a wide variety of simulators on the marked, ranging from virtual reality (VR) simulators to box-trainers, several of which have already been validated [14]. VR simulators are based on computer-generated environments and can simulate both basic tasks and full procedures.…”

Objective versus Subjective Assessment of Laparoscopic Skill

“…Furthermore, VR and AR simulators do not provide tactile (haptic) feedback. Box trainers do preserve a realistic setting including haptic feedback and augmented depth perception [8] but would lack objective assessment methods and a low fidelity to actual laparoscopic procedures [9].…”

“…Various validation studies have demonstrated objective classification of MIS skill using laparoscopic simulators, although there is little evidence that these systems can assess residents' individual laparoscopic performance correctly [8].…”