Surgical Endoscopy

, Volume 23, Issue 7, pp 1476-1482

First online:

Validation of laparoscopic surgical skills training outside the operating room: a long road

  • N. J. HogleAffiliated withDepartment of Surgery, College of Physicians and Surgeons, Columbia University
  • , L. ChangAffiliated withDepartment of Surgery, Virginia Mason Medical Center
  • , V. E. M. StrongAffiliated withMemorial Sloan-Kettering Cancer Center, Gastric and Mixed Tumor Service
  • , A. O. U. WelcomeAffiliated withDepartment of Surgery, College of Physicians and Surgeons, Columbia University
  • , M. SinaanAffiliated withDepartment of Surgery, University of Washington
  • , R. BaileyAffiliated withDepartment of Surgery, University of Miami Hospital
  • , D. L. FowlerAffiliated withDepartment of Surgery, College of Physicians and Surgeons, Columbia University Email author 

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Surgical skills training outside the operating room is beneficial. The best methods have yet to be identified. The authors aimed to document the predictive validity of simulation training in three different studies.


Study 1 was a prospective, randomized, multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training. The Global Operative Assessment of Laparoscopic Skills (GOALS) was used to evaluate operative performance. Study 2 retrospectively reviewed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum. Operative time was the variable used to determine resident improvement. Study 3 was a prospective, randomized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator. Operative performance was assessed using GOALS.


All three studies failed to demonstrate predictive validity. With GOALS used as the assessment tool, no difference was found between trained and untrained residents in studies 1 and 3. In study 2, the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group.


No correlation was found between the three types of training outside the operating room, and no improved operative performance was observed. Possible explanations include too few subjects, training introduced too late in the learning curve, and training criteria that were too easy. Additionally, simulator training focuses on precision, which may actually increase task time. Awareness of these issues can improve the design of future studies.


General surgery training Laparoscopic skills Laparoscopic surgery Negative results Simulator training Virtual reality training