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2008 Annual Meeting Abstracts

Laparoscopic Operative Skills are Predicted by Virtual Reality Simulator Performance
Lucian Panait, MD1, Kurt E. Roberts, MD2, Robert L. Bell, MD2, Michael Martinez, MD2, Stanley J. Dudrick, MD1, Andrew J. Duffy, MD2.
1Saint Mary's Hospital, Waterbury, CT, USA, 2Yale University School of Medicine, New Haven, CT, USA.

Objective: The Fundamentals of Laparoscopic Surgery (FLS) program is the most validated predictor of trainee operative performance. Laparoscopic virtual reality simulators are evolving as facilitators of resident training and assessment outside the operating room. However, limited data exist correlating simulator performance and operative skills. Utilizing the Laparoscopy VR (Immersion Medical, Gaithersburg, MD), we hypothesize that trainee performance in the simulator will correlate with surgical skill level as measured by two basic FLS tasks.
Design: Non-randomized trial
Setting: University Surgical Skills and Simulation Center
Participants: Ten subjects of variable experience (medical students, residents and attendings) volunteered and were assigned to the study.
Interventions: All subjects were familiarized with laparoscopic skills and instruments. They were evaluated for baseline skills using two FLS tasks (peg transfer and pattern cutting). Each performed two analogous tasks on the Laparoscopy VR at 3 levels of difficulty, based on manufacturer established settings.
Main Outcome Measures: A performance score was derived from data on completion time, instrument path length, and errors. Using linear regression analysis with calculation of correlation coefficients, simulator scores were assessed compared with the sum of the FLS scores.
Results: At level 2, peg transfer performance demonstrates a direct correlation with total FLS scores (R2 = 0.93). Pattern cutting correlates at level 3 (R2 = 0.75) for the entire group. Evaluating only resident and attending performance, both simulator drill scores directly correlate with the total FLS score (R2 > 0.8).
Conclusions: Laparoscopy VR performance directly correlates with trainee laparoscopic skill as determined by the FLS tasks. This simulator is a valuable tool for directly evaluating resident laparoscopic skill acquisition.


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