Can skills assessment on a virtual reality trainer predict a surgical trainee’s talent in laparoscopic surgery?

  • R. Rosenthal
  • W. A. Gantert
  • D. Scheidegger
  • D. Oertli



A number of studies have investigated several aspects of feasibility and validity of performance assessments with virtual reality surgical simulators. However, the validity of performance assessments is limited by the reliability of such measurements, and some issues of reliability still need to be addressed. This study aimed to evaluate the hypothesis that test subjects show logarithmic performance curves on repetitive trials for a component task of laparoscopic cholecystectomy on a virtual reality simulator, and that interindividual differences in performance after considerable training are significant. According to kinesiologic theory, logarithmic performance curves are expected and an individual’s learning capacity for a specific task can be extrapolated, allowing quantification of a person’s innate ability to develop task-specific skills.


In this study, 20 medical students at the University of Basel Medical School performed five trials of a standardized task on the LS 500 virtual reality simulator for laparoscopic surgery. Task completion time, number of errors, economy of instrument movements, and maximum speed of instrument movements were measured.


The hypothesis was confirmed by the fact that the performance curves for some of the simulator measurements were very close to logarithmic curves, and there were significant interindividual differences in performance at the end of the repetitive trials.


Assessment of perceptual motor skills and the innate ability of an individual with no prior experience in laparoscopic surgery to develop such skills using the LS 500 VR surgical simulator is feasible and reliable.


Laparoscopy Simulation Training Virtual reality 


  1. 1.
    Haluck RS, Krummel TM (2000) Computers and virtual reality for surgical education in the 21st century. Arch Surg 135: 786–792PubMedCrossRefGoogle Scholar
  2. 2.
    Marescaux J, Leroy J, Gagner M, Rubino F, Mutter D, Vix M, Butner SE, Smith MK (2001) Transatlantic robot-assisted telesurgery. Nature 413: 379–380PubMedCrossRefGoogle Scholar
  3. 3.
    Marescaux J, Clement JM, Tassetti V, Koehl C, Cotin S, Russier Y, Mutter D, Delingette H, Ayache N (1998) Virtual reality applied to hepatic surgery simulation: the next revolution. Ann Surg 228: 627–634PubMedCrossRefGoogle Scholar
  4. 4.
    Gorman PJ, Meier AH, Krummel TM (1999) Simulation and virtual reality in surgical education: real or unreal? Arch Surg 134: 1203–1208PubMedCrossRefGoogle Scholar
  5. 5.
    Bridges M, Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177: 28–32PubMedCrossRefGoogle Scholar
  6. 6.
    Tendick F, Downes M, Cavusoglu M, Gantert W, Way LW (1998) Development of virtual environments for training skills and reducing errors in laparoscopic surgery. SPIE Conference 3262 on Surgical-Assist Systems, San Jose, CA pp 36–44Google Scholar
  7. 7.
    Cao C, MacKenzie CL, Ibbotson JA, Turner LJ, Blair NP, Nagy AG (1999) Hierarchical decomposition of laparoscopic procedures. Stud Health Technol Inform 62: 83–89PubMedGoogle Scholar
  8. 8.
    Gallagher AG, McClure N, McGuigan J, Crothers I, Browning J (1999) Virtual reality training in laparoscopic surgery: a preliminary assessment of minimally invasive surgical traininer virtual reality (MIST-VR). Endoscopy 31: 310–313PubMedCrossRefGoogle Scholar
  9. 9.
    Szekely G, Satava RM (1999) Virtual reality in medicine. BMJ 319:1305PubMedGoogle Scholar
  10. 10.
    O’Toole RV, Playter RR, Krummel TM, Blank WC, Cornelius NH, Roberts WR, Bell WJ, Raibert M (1999) Measuring and developing suturing technique with a virtual reality surgical simulator. J Am Coll Surg 189: 114–127PubMedCrossRefGoogle Scholar
  11. 11.
    Chaudhry A, Sutton C, Wood J, Stone R, McCloy R (1999) Learning rate for laparoscopic skills on MIST-VR, a virtual simulator: quality of human–computer interface. Ann R Coll Surg Engl 81: 281–286PubMedGoogle Scholar
  12. 12.
    Taffinder NJ, McManus IC, Gul Y, Russell RCG, Darzi A (1998) Effect of sleep deprivation on surgeons’ dexterity on laparoscopy simulator. Lancet 352: 1191PubMedCrossRefGoogle Scholar
  13. 13.
    Darzi A, Smith S, Taffinder N (1999) Assessing operative skill: needs to become more objective. BMJ 318: 887–888PubMedGoogle Scholar
  14. 14.
    Devitt JH, Kurrek MM, Cohen MM, Cleave-Hogg D (2001) The validity of performance assessments using simulation. Anesthesiology 95: 36–42PubMedCrossRefGoogle Scholar
  15. 15.
    Jordan JA, Gallagher AG, McGuigan J, McGlade K, McClure N (2000) A comparison between randomly alternative imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition. Am J Surg 180: 208–211PubMedCrossRefGoogle Scholar
  16. 16.
    Schijven MP, Jakimowicz J (2004) The learning curve on the Xitact LS 500 laparoscopy simulator: profiles of performance. Surg Endosc 18: 121–127PubMedCrossRefGoogle Scholar
  17. 17.
    Schijven MP, Jakimowicz J (2002) Face, expert, and a referent validity of the Xitact LS 500 laparoscopy simulator. Surg Endosc 16: 1764–1770PubMedCrossRefGoogle Scholar
  18. 18.
    Schijven MP, Jakimowicz J (2003) Construct validity: experts and residents performing on the Xitact LS500 laparoscopy simulator. Surg Endosc 17: 803–810PubMedCrossRefGoogle Scholar
  19. 19.
    Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91: 146–150PubMedCrossRefGoogle Scholar
  20. 20.
    Risucci DA, Tortolani AJ (1990) A methodological framework for the design of research on the evaluation of residents. Acad Med 65: 36–41PubMedCrossRefGoogle Scholar
  21. 21.
    Schmidt RA (1982) Motor control and learning: a behavioral emphasis. Human Kinetics Publishers, Champaign, ILGoogle Scholar
  22. 22.
    Ivry R (1996) Representational issues in motor learning: phenomena and theory. In: Handbook of perception and action. Academic Press, San Diego, CAGoogle Scholar
  23. 23.
    Hanna GB, Drew T, Clinch P, Shimi S, Dunkley P, Hau C, Cuschieri A (1997) Psychomotor skills for endoscopic manipulations: differing abilities between right- and left-handed individuals. Ann Surg 225: 333–338PubMedCrossRefGoogle Scholar
  24. 24.
    Reznick R (1993) Teaching and testing technical skills. Am J Surg 165: 358–361PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • R. Rosenthal
    • 1
  • W. A. Gantert
    • 1
  • D. Scheidegger
    • 2
  • D. Oertli
    • 1
  1. 1.Department of SurgeryUniversitätsspital BaselBaselSwitzerland
  2. 2.Department of AnesthesiaUniversitätsspital BaselBaselSwitzerland

Personalised recommendations