Advertisement

Surgical Endoscopy

, Volume 28, Issue 9, pp 2547–2554 | Cite as

Short-duration virtual reality simulation training positively impacts performance during laparoscopic colectomy in animal model: results of a single-blinded randomized trial

VR warm-up for laparoscopic colectomy
  • Sergio E. A. AraujoEmail author
  • Conor P. Delaney
  • Victor E. Seid
  • Antonio R. Imperiale
  • Alexandre B. Bertoncini
  • Sergio C. Nahas
  • Ivan Cecconello
Article

Abstract

Background

Several studies have demonstrated skills transfer after virtual reality (VR) simulation training in laparoscopic surgery. However, the impact of VR simulation training on transfer of skills related to laparoscopic colectomy remains not investigated. The present study aimed at determining the impact of VR simulation warm-up on performance during laparoscopic colectomy in the porcine model.

Methods

Fourteen residents naive to laparoscopic colectomy as surgeons were randomly assigned in block to two groups. Seven trainees completed a 2-h VR simulator training in the laparoscopic sigmoid colectomy module (study group). The remaining seven surgeons (control group) underwent no intervention. On the same day, all participants performed a sigmoid colectomy with anastomosis on a pig. All operations were video recorded. Two board-certified expert colorectal surgeons independently assessed performance during the colectomy on the swine. Examiners were blinded to group assignment. The two examiners used a previously validated clinical instrument specific to laparoscopic colectomy. The primary outcome was the generic and specific skills score values.

Results

Surgeons undergoing short-duration training on the VR simulator performed significantly better during laparoscopic colectomy on the pig regarding general and specific technical skills evaluation. The average score of generic skills was 17.2 (16.5–18) for the control group and 20.1 (16.5–22) for the study group (p = 0.002). The specific skills average score for the control group was 20.2 (19–21.5) and 24.2 (21–27.5) for the study group (p = 0.001). There was acceptable concordance (Kendall’s W) regarding the video assessment of generic (W = 0.78) and specific skills (W = 0.84) between the two examiners.

Conclusions

A single short-duration VR simulator practice positively impacted surgeons’ generic and specific skills performance required to accomplish laparoscopic colectomy in the swine model.

Keywords

Laparoscopy Colectomy Colonic neoplasms Education Credentialing Clinical skills 

Notes

Disclosures

Drs. Sergio Eduardo Alonso Araujo, Conor Patrick Delaney, Victor Edmond Seid, Antonio Rocco Imperiale, Alexandre Bruno Bertoncini, Sergio Carlos Nahas, and Ivan Cecconello have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Scott DJ, Cendan JC, Pugh CM, Minter RM, Dunnington GL, Kozar RA (2008) The changing face of surgical education: simulation as the new paradigm. J Surg Res 147:189–193PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Sarker SK, Kumar I, Delaney C (2010) Assessing operative performance in advanced laparoscopic colorectal surgery. World J Surg 34:1594–1603PubMedCrossRefGoogle Scholar
  3. 3.
    Larsen CR, Oestergaard J, Ottesen BS, Soerensen JL (2012) The efficacy of virtual reality simulation training in laparoscopy: a systematic review of randomized trials. Acta Obstet Gynecol Scand 91:1015–1028PubMedCrossRefGoogle Scholar
  4. 4.
    Zendejas B, Brydges R, Hamstra SJ, Cook DA (2013) State of the evidence on simulation-based training for laparoscopic surgery: a systematic review. Ann Surg 257:586–593PubMedCrossRefGoogle Scholar
  5. 5.
    Satava RM (1993) Virtual reality surgical simulator: the first steps. Surg Endosc 7:203–205PubMedCrossRefGoogle Scholar
  6. 6.
    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
  7. 7.
    Gallagher AG, Seymour NE, Jordan-Black J-A, Bunting BP, McGlade K, Satava RM (2013) Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition. Ann Surg 257:1025–1031PubMedCrossRefGoogle Scholar
  8. 8.
    Torkington J, Smith SG, Rees BI, Darzi A (2001) Skill transfer from virtual reality to a real laparoscopic task. Surg Endosc 15:1076–1079PubMedCrossRefGoogle Scholar
  9. 9.
    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Stava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Andreatta PB, Woodrum DT, Birkmeyer JD, Yellamanchilli RK, Doherty GM, Gauger PG, Minter RM (2006) Laparoscopic skills are improved with LapMentor training: results of a randomized, double-blinded study. Ann Surg 243:854–860PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA 3rd, 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 193:797–804PubMedCrossRefGoogle Scholar
  12. 12.
    Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R, Hop WCJ, Kuhry E, Jeekel J, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy A, Bonjer HJ (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10:44–52PubMedCrossRefGoogle Scholar
  13. 13.
    Lacy AM, Delgado S, Castells A, Prins HA, Arroyo V, Ibarzabal A, Pique JM (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7PubMedCrossRefGoogle Scholar
  14. 14.
    Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW Jr, Hellinger M, Flanagan R Jr, Peters W, Nelson H (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662PubMedCrossRefGoogle Scholar
  15. 15.
    Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AMH, Heath RM, Brown JM (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068PubMedCrossRefGoogle Scholar
  16. 16.
    Bardakcioglu O, Khan A, Aldridge C, Chen J (2013) Growth of laparoscopic colectomy in the United States: analysis of regional and socioeconomic factors over time. Ann Surg 258:270–274PubMedCrossRefGoogle Scholar
  17. 17.
    Kemp JA, Finlayson SRG (2008) Nationwide trends in laparoscopic colectomy from 2000 to 2004. Surg Endosc 22(5):1181–1187PubMedCrossRefGoogle Scholar
  18. 18.
    Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB (2010) Systematic review on mentoring and simulation in laparoscopic colorectal surgery. Ann Surg 252:943–951PubMedCrossRefGoogle Scholar
  19. 19.
    LeBlanc F, Champagne BJ, Augestad KM, Neary PC, Senagore AJ, Ellis CN, Delaney CP (2010) A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg 211:250–255PubMedCrossRefGoogle Scholar
  20. 20.
    Calatayud D, Arora S, Aggarwal R, Kruglikova I, Schulze S, Funch-Jensen P, Grantcharov T (2010) Warm-up in a virtual reality environment improves performance in the operating room. Ann Surg 251:1181–1185PubMedCrossRefGoogle Scholar
  21. 21.
    Kahol K, Satava RM, Ferrara J, Smith ML (2009) Effect of short-term pretrial practice on surgical proficiency in simulated environments: a randomized trial of the “preoperative warm-up” effect. J Am Coll Surg 208:255–268PubMedCrossRefGoogle Scholar
  22. 22.
    Moldovanu R, Târcoveanu E, Dimofte G, Lupaşcu C, Bradea C (2011) Preoperative warm-up using a virtual reality simulator. JSLS 15:533–538PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Schulz KF, Altman DG, Moher D (2010) CONSORT Group CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 152:726–732PubMedCrossRefGoogle Scholar
  24. 24.
    Aggarwal R, Grantcharov T, Moorthy K, Hance J, Darzi A (2006) A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. Am J Surg 191:128–133PubMedCrossRefGoogle Scholar
  25. 25.
    Do AT, Cabbad MF, Kerr A, Serur E, Robertazzi RR, Stankovic MR (2006) A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of Ob-Gyn residents: a low-cost laparoscopic trainer. JSLS 10:297–301PubMedCentralPubMedGoogle Scholar
  26. 26.
    Lee JY, Mucksavage P, Kerbl DC, Osann KE, Winfield HN, Kahol K, McDougall EM (2012) Laparoscopic warm-up exercises improve performance of senior-level trainees during laparoscopic renal surgery. J Endourol Endourol Soc 26:545–550CrossRefGoogle Scholar
  27. 27.
    Sarker SK, Chang A, Vincent C, Darzi SA (2006) Development of assessing generic and specific technical skills in laparoscopic surgery. Am J Surg 191:238–244PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sergio E. A. Araujo
    • 1
    • 2
    • 6
    Email author
  • Conor P. Delaney
    • 3
    • 4
  • Victor E. Seid
    • 2
  • Antonio R. Imperiale
    • 2
  • Alexandre B. Bertoncini
    • 2
  • Sergio C. Nahas
    • 1
    • 2
  • Ivan Cecconello
    • 1
    • 5
  1. 1.Department of GastroenterologyUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  2. 2.Colorectal Surgery DivisionUniversity of Sao Paulo Medical CenterSão PauloBrazil
  3. 3.Case Western Reserve University Center for Skills and SimulationClevelandUSA
  4. 4.Digestive Health Institute University Hospitals Case Medical CenterCase Western Reserve UniversityClevelandUSA
  5. 5.Digestive Surgery DivisionUniversity of Sao Paulo Medical CenterSão PauloBrazil
  6. 6.São PauloBrazil

Personalised recommendations