Surgical Endoscopy

, Volume 21, Issue 12, pp 2253–2257 | Cite as

Construct validity for eye–hand coordination skill on a virtual reality laparoscopic surgical simulator

  • Shohei Yamaguchi
  • Kozo Konishi
  • Takefumi Yasunaga
  • Daisuke Yoshida
  • Nao Kinjo
  • Kiichiro Kobayashi
  • Satoshi Ieiri
  • Ken Okazaki
  • Hideaki Nakashima
  • Kazuo Tanoue
  • Yoshihiko Maehara
  • Makoto Hashizume



This study was carried out to investigate whether eye-hand coordination skill on a virtual reality laparoscopic surgical simulator (the LAP Mentor) was able to differentiate among subjects with different laparoscopic experience and thus confirm its construct validity.


A total of 31 surgeons, who were all right-handed, were divided into the following two groups according to their experience as an operator in laparoscopic surgery: experienced surgeons (more than 50 laparoscopic procedures) and novice surgeons (fewer than 10 laparoscopic procedures). The subjects were tested using the eye-hand coordination task of the LAP Mentor, and performance was compared between the two groups. Assessment of the laparoscopic skills was based on parameters measured by the simulator.


The experienced surgeons completed the task significantly faster than the novice surgeons. The experienced surgeons also achieved a lower number of movements (NOM), better economy of movement (EOM) and faster average speed of the left instrument than the novice surgeons, whereas there were no significant differences between the two groups for the NOM, EOM and average speed of the right instrument.


Eye-hand coordination skill of the nondominant hand, but not the dominant hand, measured using the LAP Mentor was able to differentiate between subjects with different laparoscopic experience. This study also provides evidence of construct validity for eye-hand coordination skill on the LAP Mentor.


LAP Mentor Virtual reality Construct validity Laparoscopic surgical simulator Laparoscopy Surgical education 


  1. 1.
    Adamsen S, Funch-Jensen PM, Drewes AM, Rosenberg J, Grantcharov TP (2005) A comparative study of skills in virtual laparoscopy and endoscopy. Surg Endosc 19: 229–234CrossRefPubMedGoogle Scholar
  2. 2.
    Chaudhry A, Sutton C, Wood J, Stone R, McCloy R (1999) Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human-computer interface. Ann R Coll Surg Engl 81: 281–286PubMedGoogle Scholar
  3. 3.
    Crothers IR, Gallagher AG, McClure N, James DT, McGuigan J (1999) Experienced laparoscopic surgeons are automated to the “fulcrum effect”: an ergonomic demonstration. Endoscopy 31: 365–369CrossRefPubMedGoogle Scholar
  4. 4.
    Duffy AJ, Hogle NJ, McCarthy H, Lew JI, Egan A, Christos P, Fowler DL (2005) Construct validity for the LapSim laparoscopic surgical simulator. Surg Endosc 19: 401–405CrossRefPubMedGoogle Scholar
  5. 5.
    Eriksen JR, Grantcharov T (2005) Objective assessment of laparoscopic skills using a virtual reality simulator. Surg Endosc 19: 1216–1219CrossRefPubMedGoogle Scholar
  6. 6.
    Figert PL, Park AE, Witzke DB, Schwartz RW (2001) Transfer of training in acquiring laparoscopic skills. J Am Coll Surg 193: 533–537CrossRefPubMedGoogle Scholar
  7. 7.
    Gallagher AG, McClure N, McGuigan J, Ritchie K, Sheehy NP (1998) An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. Endoscopy 30: 617–620CrossRefPubMedGoogle 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 trainer virtual reality (MIST VR). Endoscopy 31: 310–313CrossRefPubMedGoogle Scholar
  9. 9.
    Gallagher AG, Richie K, McClure N, McGuigan J (2001) Objective psychomotor skills assessment of experienced, junior, and novice laparoscopists with virtual reality. World J Surg 25: 1478–1483CrossRefPubMedGoogle Scholar
  10. 10.
    Gallagher AG, Satava RM (2002) Virtual reality as a metric for the assessment of laparoscopic psychomotor skills. Learning curves and reliability measures. Surg Endosc 16: 1746–1752CrossRefPubMedGoogle Scholar
  11. 11.
    Gallagher AG, Lederman AB, McGlade K, Satava RM, Smith CD (2004) Discriminative validity of the Minimally Invasive Surgical Trainer in Virtual Reality (MIST-VR) using criteria levels based on expert performance. Surg Endosc 18: 660–665CrossRefPubMedGoogle Scholar
  12. 12.
    Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J (2003) Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. Am J Surg 185: 146–149CrossRefPubMedGoogle Scholar
  13. 13.
    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: 146–150CrossRefPubMedGoogle Scholar
  14. 14.
    Grantcharov TP, Rosenberg J, Pahle E, Funch-Jensen P (2001) Virtual reality computer simulation. Surg Endosc 15: 242–244CrossRefPubMedGoogle Scholar
  15. 15.
    Hyltander A, Liljegren E, Rhodin PH, Lonroth H (2002) The transfer of basic skills learned in a laparoscopic simulator to the operating room. Surg Endosc 16: 1324–1328CrossRefPubMedGoogle Scholar
  16. 16.
    Korndorffer JR, Dunne JB, Sierra R, Stefanidis D, Touchard CL, Scott DJ (2005) Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg 201: 23–29CrossRefPubMedGoogle Scholar
  17. 17.
    Maithel S, Sierra R, Korndorffer J, Neumann P, Dawson S, Callery M, Jones D, Scott D (2006) Construct and face validity of MIST-VR, Endotower, and CELTS: are we ready for skills assessment using simulators? Surg Endosc 20: 104–112CrossRefPubMedGoogle Scholar
  18. 18.
    McDougall EM, Corica FA, Boker JR, Sala LG, Stoliar G, Borin JF, Chu FT, Clayman RV (2006) Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg 202: 779–787CrossRefPubMedGoogle Scholar
  19. 19.
    McNatt SS, Smith CD (2001) A computer-based laparoscopic skill assessment device differentiates experienced from novice laparoscopic surgeons. Surg Endosc 15: 1085–1089CrossRefPubMedGoogle Scholar
  20. 20.
    Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainer: is one superior to the other? Surg Endosc 18: 485–494CrossRefPubMedGoogle Scholar
  21. 21.
    Ro CY, Toumpoulis IK, Ashton RC Jr., Jebara T, Schulman C, Todd GJ, Derose JJ Jr, McGinty JJ (2005) The LapSim: a learning environment for both experts and novices. Stud Health Technol Inform 111: 414–417PubMedGoogle Scholar
  22. 22.
    Schijven M, Jakimowicz J (2003) Virtual reality surgical laparoscopic simulators. Surg Endosc 17: 1943–1950CrossRefPubMedGoogle Scholar
  23. 23.
    Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191: 272–283CrossRefPubMedGoogle Scholar
  24. 24.
    Scott DJ, Valentine RJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Jones DB (2000) Evaluating surgical competency with the American Board of Surgery in-training examination, skill testing, and intraoperative assessment. Surgery 128: 613–622CrossRefPubMedGoogle Scholar
  25. 25.
    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236: 458–463CrossRefPubMedGoogle Scholar
  26. 26.
    Sherman V, Feldman LS, Stanbridge D, Kazmi R, Fried GM (2005) Assessing the learning curve for the acquisition of laparoscopic skills on a virtual reality simulator. Surg Endosc 19: 678–682CrossRefPubMedGoogle Scholar
  27. 27.
    Sutton C, McCloy R, Middlebrook A, Chater P, Wilson M, Stone R (1997) MIST VR. A laparoscopic surgery procedures trainer and evaluator. Stud Health Technol Inform 39: 598–607PubMedGoogle Scholar
  28. 28.
    Taffinder N, Sutton C, Fishwick RJ, McManus IC, Darzi A (1998) Validation of virtual reality to teach and assess psychomotor skills in laparoscopic surgery: results from randomized controlled studies using the MIST-VR laparoscopic simulator. Stud Health Technol Inform 50: 124–130PubMedGoogle Scholar
  29. 29.
    Woodrum DT, Andreatta PB, Yellamanchilli RK, Feryus L, Gauger PG, Minter RM (2006) Construct validity of the LapSim laparoscopic surgical simulator. Am J Surg 191: 28–32CrossRefPubMedGoogle Scholar
  30. 30.
    Youngblood PL, Srivastava S, Curet M, Heinrichs WL, Dev P, Wren SM (2005) Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance. J Am Coll Surg 200: 546–551CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Shohei Yamaguchi
    • 1
  • Kozo Konishi
    • 2
  • Takefumi Yasunaga
    • 1
  • Daisuke Yoshida
    • 1
  • Nao Kinjo
    • 3
  • Kiichiro Kobayashi
    • 4
  • Satoshi Ieiri
    • 5
  • Ken Okazaki
    • 2
  • Hideaki Nakashima
    • 2
  • Kazuo Tanoue
    • 5
  • Yoshihiko Maehara
    • 3
  • Makoto Hashizume
    • 1
  1. 1.Department of Disaster and Emergency MedicineGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
  2. 2.Department of Innovative Medical TechnologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
  3. 3.Department of Surgery and ScienceGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
  4. 4.Department of Surgery and OncologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
  5. 5.Department of Advanced Medicine and Innovative TechnologyKyushu University HospitalFukuokaJapan

Personalised recommendations