The learning curve on the Xitact LS 500 laparoscopy simulator: profiles of performance

Original article

Abstract

Background: This study assesses the acquisition of skill and the learning curve associated with the performance of the clip-and-cut task on the Xitact LS 500 virtual reality (VR) simulator in laparoscopic cholecystectomy.Methods: A group of 33 residents and interns with no previous laparoscopic experience participated in the study. All participants received a 1-h familiarization tour on the simulator. Thirty participants completed a full course of 30 simulation runs over 3 days (10 runs per day). The outcome parameters were a previously validated sum-score and time to complete performance. Results: Group demographics were similar. Of the participants who completed the full study, 16.7% appeared to have such a high level of innate psychomotor abilities that they were considered proficient in the task immediately after the initial familiarization tour. Most participants (63.3%) had a moderate level of innate abilities, and their performance improved through repetitive VR training. In our study, 20% of the participants had such a low level of innate abilities that they were unable to achieve an acceptable performance in our minimal-access surgery (MAS) simulation.Conclusions: Learning curves cannot be assessed by examining the repetitive training of only one person. There seem to be four different performance profiles, reflecting the fact that some people are more adept than others to be trained by MAS procedural VR simulation. For participants receptive to training—63.3% in this study—proficiency in the task occurs after ~25 simulative runs.

Keywords

Virtual reality Minimal-access surgery Simulation Learning curve Validation Surgical training 

References

  1. 1.
    Ali, MR, Mowery, Y, Kaplan, B, De Maria, EJ 2002Training the novice in laparoscopy: more challenge is better .Surg Endosc1617231736CrossRefGoogle Scholar
  2. 2.
    Bevan, PG 1986Crafts workshops in surgery.Br J Surg7312Google Scholar
  3. 3.
    Coleman, J, NDuka, CC, Darzi, A 1994Virtual reality and laparoscopic surgery.Br J Surg8117091711PubMedGoogle Scholar
  4. 4.
    Cosman, PH, Cregan, PC, Martin, CJ, Cartmill, JA 2002Virtual reality simulators: current status in acquisition and of surgical skills.Aust AN Z J Surg723034CrossRefGoogle Scholar
  5. 5.
    Deziel, D, Milikan, KW, Economon, SG, Doolas, A, Ko, ST, Airan, MC 1993Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases.Am J Surg165914PubMedGoogle Scholar
  6. 6.
    Farrell, A 2002Can virtual reality be used to measure and train surgical skills?.Ergonomics45362379CrossRefPubMedGoogle Scholar
  7. 7.
    Gallagher, A, Satava, M 2002Virtual reality as a metric for the assessment of laparoscopic psychomotor skills.Surg Endosc1617461752PubMedGoogle Scholar
  8. 8.
    Grantcharov TP (2002) Teaching and testing surgical skills on a VR laparoscopy simulator: learning curves and effect of previous operative experience on performance. 10th International Congress of the European Association for Endoscopic Surgery (EAES), Lisbon, PortugalGoogle Scholar
  9. 9.
    Grantcharov, TP, Baruran, L, Fuch-Jensen, P, Rosenberg, J 2003Learning curves and impact of previous operative experience on performing on a virtual reality simulator to test laparoscopic surgical skills.Am J Surg185146149PubMedGoogle Scholar
  10. 10.
    Hamdorf, JM, Hall, JC 2000Acquiring surgical skills.Br J Surg872837CrossRefPubMedGoogle Scholar
  11. 11.
    Melvin, SW, Johnson, JA, Ellison, CE 1996Laparoscopic skills enhancement.Am J Surg172377379CrossRefPubMedGoogle Scholar
  12. 12.
    Moore, MJ, Bennett, CL 1995The learning curve for laparoscopic cholecystectomy.Am J Surg1705559CrossRefPubMedGoogle Scholar
  13. 13.
    Peters, JH, Ellison, EC, Innes, JT 1991Safety and efficacy of laparoscopic cholecystectomy.Ann Surg312312Google Scholar
  14. 14.
    Ramsay, CR,  et al. 2001Statistical assessment of the learning curves of health technologies.Health Technol Assess5198Google Scholar
  15. 15.
    Satava, MR, Cushieri, A, Hamdorf, J 2003Metrics for objective assessment: preliminary summary of the Surgical Skills Workshop.Surg Endosc172202226CrossRefPubMedGoogle Scholar
  16. 16.
    Schijven, M, Jakimowicz, J 2002Face, expert, and referent validity of the Xitact LS 500 laparoscopy simulator.Surg Endosc1617641770CrossRefPubMedGoogle Scholar
  17. 17.
    Schijven, M, Jakimowicz, J 2002Construct validity: experts and residents performing on the Xitact LS 500 laparoscopy simulator.Surg Endosc..(In press)Google Scholar
  18. 18.
    Schijven, MP, Jakimowicz, J, Schot, C 2002The Advanced Dundee Endoscopic Psychomotor Tester (ADEPT) objectifying subjective psychomotor test performance.Surg Endosc16943948CrossRefPubMedGoogle Scholar
  19. 19.
    Southern Surgeons Club1995The learning curve for laparoscopic cholecystectomy.Am J Surgxx5559Google Scholar
  20. 20.
    Strorn, P,  et al. 2003Validation and learning in the Procedicus KSA virtual reality surgical simulator: implementing a new safety culture in medical school.Surg Endosc17227231CrossRefPubMedGoogle Scholar
  21. 21.
    Wanzel, KR, Ward, M, Reznick, RK 2002Teaching the surgical craft: from selection to certification.Curr Probl Surg39574659Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of SurgeryCatharina Hospital Eindhoven, Michelangelolaan 2, P.O. Box 1350, 5602 ZA EindhovenThe Netherlands

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