Surgical Endoscopy

, Volume 23, Issue 7, pp 1476–1482

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


  • N. J. Hogle
    • Department of Surgery, College of Physicians and SurgeonsColumbia University
  • L. Chang
    • Department of SurgeryVirginia Mason Medical Center
  • V. E. M. Strong
    • Memorial Sloan-Kettering Cancer CenterGastric and Mixed Tumor Service
  • A. O. U. Welcome
    • Department of Surgery, College of Physicians and SurgeonsColumbia University
  • M. Sinaan
    • Department of SurgeryUniversity of Washington
  • R. Bailey
    • Department of SurgeryUniversity of Miami Hospital
    • Department of Surgery, College of Physicians and SurgeonsColumbia University

DOI: 10.1007/s00464-009-0379-5

Cite this article as:
Hogle, N.J., Chang, L., Strong, V.E.M. et al. Surg Endosc (2009) 23: 1476. doi:10.1007/s00464-009-0379-5



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 trainingLaparoscopic skillsLaparoscopic surgeryNegative resultsSimulator trainingVirtual reality training

Copyright information

© Springer Science+Business Media, LLC 2009