Surgical Endoscopy

, Volume 25, Issue 2, pp 343–355 | Cite as

The LapSim virtual reality simulator: promising but not yet proven

  • Katherine Fairhurst
  • Andrew Strickland
  • Guy Maddern



The acquisition of technical skills using surgical simulators is an area of active research and rapidly evolving technology. The LapSim is a virtual reality simulator that currently allows practice of basic laparoscopic skills and some procedures. To date, no reviews have been published with reference to a single virtual reality simulator.


A PubMed search was performed using the keyword “LapSim,” with further papers identified from the citations of original search articles.


Use of the LapSim to develop surgical skills has yielded overall results, although inconsistencies exist. Data regarding the transferability of learned skills to the operative environment are encouraging as is the validation work, particularly the use of a combination of measured parameters to produce an overall comparative performance score.


Although the LapSim currently does not have any proven significant advantages over video trainers in terms of basic skills instruction and although the results of validation studies are variable, the potential for such technology to have a huge impact on surgical training is apparent. Work to determine standardized learning curves and proficiency criteria for different levels of trainees is incomplete. Moreover, defining which performance parameters measured by the LapSim accurately determine laparoscopic skill is complex. Further technological advances will undoubtedly improve the efficacy of the LapSim, and the results of large multicenter trials are anticipated.


LapSim Simulation training Virtual reality 



Katherine Fairhurst, Andrew Strickland, and Guy Maddern have no conflicts of interest or financial ties to disclose.


  1. 1.
    The Intercollegiate Surgical Curriculum Project. Retrieved 17 September 2009
  2. 2.
    Soper NJ, Fried GM (2008) The fundamentals of laparoscopic surgery: its time has come. Bull Am Coll Surg 93:30–32PubMedGoogle Scholar
  3. 3.
    Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR (2009) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev CD006575Google Scholar
  4. 4.
    Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, Jakimowicz JJ (2005) Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19:1523–1532CrossRefPubMedGoogle Scholar
  5. 5.
    Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300CrossRefPubMedGoogle Scholar
  6. 6.
    van der Meijden OA, Schijven MP (2009) The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc 23:1180–1190CrossRefPubMedGoogle Scholar
  7. 7.
    Tsuda S, Scott D, Doyle J, Jones DB (2009) Surgical skills training and simulation. Curr Probl Surg 46:271–370CrossRefPubMedGoogle Scholar
  8. 8.
    Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248:166–179CrossRefPubMedGoogle Scholar
  9. 9.
    SurgicalScience. Retrieved 8 September 2009
  10. 10.
    Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS (2009) Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 338:b1802CrossRefPubMedGoogle Scholar
  11. 11.
    Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA III, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193:797–804CrossRefPubMedGoogle Scholar
  12. 12.
    Cosman PH, Hugh TJ, Shearer CJ, Merrett ND, Biankin AV, Cartmill JA (2007) Skills acquired on virtual reality laparoscopic simulators transfer into the operating room in a blinded, randomised, controlled trial. Stud Health Technol Inform 125:76–81PubMedGoogle Scholar
  13. 13.
    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
  14. 14.
    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
  15. 15.
    SimuLab Corporation. Retrieved 15 September 2009
  16. 16.
    Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc 18:485–494CrossRefPubMedGoogle Scholar
  17. 17.
    Newmark J, Dandolu V, Milner R, Grewal H, Harbison S, Hernandez E (2007) Correlating virtual reality and box trainer tasks in the assessment of laparoscopic surgical skills. Am J Obstet Gynecol 197:546e1–546e4CrossRefGoogle Scholar
  18. 18.
    Munz Y, Almoudaris AM, Moorthy K, Dosis A, Liddle AD, Darzi AW (2007) Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 193:774–783CrossRefPubMedGoogle Scholar
  19. 19.
    Mentice. Retrieved 15 September 2009
  20. 20.
    Hogle NJ, Widmann WD, Ude AO, Hardy MA, Fowler DL (2008) Does training novices to criteria and does rapid acquisition of skills on laparoscopic simulators have predictive validity or are we just playing video games? J Surg Educ 65:431–435CrossRefPubMedGoogle Scholar
  21. 21.
    Hogle NJ, Chang L, Strong VE, Welcome AO, Sinaan M, Bailey R, Fowler DL (2009) Validation of laparoscopic surgical skills training outside the operating room: a long road. Surg Endosc 23:1476–1482CrossRefPubMedGoogle Scholar
  22. 22.
    Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondre K, Stanbridge D, Fried GM (2005) A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 190:107–113CrossRefPubMedGoogle Scholar
  23. 23.
    Botden SM, Buzink SN, Schijven MP, Jakimowicz JJ (2007) Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator. World J Surg 31:764–772CrossRefPubMedGoogle Scholar
  24. 24.
    Pellen MG, Horgan LF, Barton JR, Attwood SE (2009) Construct validity of the ProMIS laparoscopic simulator. Surg Endosc 23:130–139CrossRefPubMedGoogle Scholar
  25. 25.
    Pellen M, Horgan L, Roger Barton J, Attwood S (2009) Laparoscopic surgical skills assessment: can simulators replace experts? World J Surg 33:440–447CrossRefPubMedGoogle Scholar
  26. 26.
    Aggarwal R, Grantcharov TP, Eriksen JR, Blirup D, Kristiansen VB, Funch-Jensen P, Darzi A (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244:310–314CrossRefPubMedGoogle Scholar
  27. 27.
    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
  28. 28.
    Eriksen JR, Grantcharov T (2005) Objective assessment of laparoscopic skills using a virtual reality stimulator. Surg Endosc 19:1216–1219CrossRefPubMedGoogle Scholar
  29. 29.
    Hassan I, Sitter H, Schlosser K, Zielke A, Rothmund M, Gerdes B (2005) A virtual reality simulator for objective assessment of surgeons’ laparoscopic skill. Chirurg 76:151–156CrossRefPubMedGoogle Scholar
  30. 30.
    Langelotz C, Kilian M, Paul C, Schwenk W (2005) LapSim virtual reality laparoscopic simulator reflects clinical experience in German surgeons. Langenbecks Arch Surg 390:534–537CrossRefPubMedGoogle Scholar
  31. 31.
    Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sorensen JL, Dalsgaard T, Ottesen B (2006) Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc 20:1460–1466CrossRefPubMedGoogle Scholar
  32. 32.
    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
  33. 33.
    van Dongen KW, Tournoij E, van der Zee DC, Schijven MP, Broeders IA (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21:1413–1417CrossRefPubMedGoogle Scholar
  34. 34.
    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
  35. 35.
    Danila R, Gerdes B, Ulrike H, Dominguez Fernandez E, Hassan I (2009) Objective evaluation of minimally invasive surgical skills for transplantation: surgeons using a virtual reality simulator. Chirurgia Bucur 104:181–185PubMedGoogle Scholar
  36. 36.
    Panait L, Bell RL, Roberts KE, Duffy AJ (2008) Designing and validating a customized virtual reality-based laparoscopic skills curriculum. J Surg Educ 65:413–417CrossRefPubMedGoogle Scholar
  37. 37.
    Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A (2007) Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 246:771–779CrossRefPubMedGoogle Scholar
  38. 38.
    Dosis A, Aggarwal R, Bello F, Moorthy K, Munz Y, Gillies D, Darzi A (2005) Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 140:293–299CrossRefPubMedGoogle Scholar
  39. 39.
    Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273–278CrossRefPubMedGoogle Scholar
  40. 40.
    Hassan I, Maschuw K, Rothmund M, Koller M, Gerdes B (2006) Novices in surgery are the target group of a virtual reality training laboratory. Eur Surg Res 38:109–113CrossRefPubMedGoogle Scholar
  41. 41.
    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
  42. 42.
    Hassan I, Koller M, Zielke A, Lehmann K, Rothmund M, Gerdes B (2006) Improvement of surgical skills after a three-day practical course for laparoscopic surgery. Swiss Med Wkly 136:631–636PubMedGoogle Scholar
  43. 43.
    Hassan I, Gerdes B, Koller M, Langer P, Rothmund M, Zielke A (2006) Clinical background is required for optimum performance with a VR laparoscopy simulator. Comput Aided Surg 11:103–106CrossRefPubMedGoogle Scholar
  44. 44.
    Panait L, Rafiq A, Tomulescu V, Boanca C, Popescu I, Carbonell A, Merrell RC (2006) Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc 20:113–118CrossRefPubMedGoogle Scholar
  45. 45.
  46. 46.
    Kundhal PS, Grantcharov TP (2009) Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room. Surg Endosc 23:645–649CrossRefPubMedGoogle Scholar
  47. 47.
    Tomulescu V, Popescu I (2004) The use of LapSim virtual reality simulator in the evaluation of laparoscopic surgery skill: preliminary results. Chirurgia Bucur 99:523–527PubMedGoogle Scholar
  48. 48.
    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
  49. 49.
    Faulkner H, Regehr G, Martin J, Reznick R (1996) Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 71:1363–1365CrossRefPubMedGoogle Scholar
  50. 50.
    Hogle NJ, Briggs WM, Fowler DL (2007) Documenting a learning curve and test–retest reliability of two tasks on a virtual reality training simulator in laparoscopic surgery. J Surg Educ 64:424–430CrossRefPubMedGoogle Scholar
  51. 51.
    Schlosser K, Alkhawaga M, Maschuw K, Zielke A, Mauner E, Hassan I (2007) Training of laparoscopic skills with virtual reality simulator:a critical reappraisal of the learning curve. Eur Surg 39:180–184CrossRefGoogle Scholar
  52. 52.
    Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A, Darzi A (2006) Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 113:1382–1387CrossRefPubMedGoogle Scholar
  53. 53.
    Sinha P, Hogle NJ, Fowler DL (2008) Do the laparoscopic skills of trainees deteriorate over time? Surg Endosc 22:2018–2025CrossRefPubMedGoogle Scholar
  54. 54.
    Salgado J, Grantcharov TP, Papasavas PK, Gagne DJ, Caushaj PF (2009) Technical skills assessment as part of the selection process for a fellowship in minimally invasive surgery. Surg Endosc 23:641–644CrossRefPubMedGoogle Scholar
  55. 55.
    Darzi A, Smith S, Taffinder N (1999) Assessing operative skill: needs to become more objective. BMJ 318:887–888PubMedGoogle Scholar
  56. 56.
    Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, Zielke A (2006) Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg 93:1554–1559CrossRefPubMedGoogle Scholar
  57. 57.
    Schuetz M, Gockel I, Beardi J, Hakman P, Dunschede F, Moenk S, Heinrichs W, Junginger T (2008) Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario. Surg Endosc 22:1263–1267CrossRefPubMedGoogle Scholar
  58. 58.
    Maschuw K, Osei-Agyemang T, Weyers P, Danila R, Bin Dayne K, Rothmund M, Hassan I (2008) The impact of self-belief on laparoscopic performance of novices and experienced surgeons. World J Surg 32:1911–1916CrossRefPubMedGoogle Scholar
  59. 59.
    Hassan I, Gerdes B, Koller M, Dick B, Hellwig D, Rothmund M, Zielke A (2007) Spatial perception predicts laparoscopic skills on virtual reality laparoscopy simulator. Childs Nerv Syst 23:685–689CrossRefPubMedGoogle Scholar
  60. 60.
    Amercian College of Surgeons. Retrieved 18 September 2009

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Katherine Fairhurst
    • 1
  • Andrew Strickland
    • 1
  • Guy Maddern
    • 1
  1. 1.Department of SurgeryThe Queen Elizabeth HospitalAdelaideAustralia

Personalised recommendations