Validation of the VBLaST peg transfer task: a first step toward an alternate training standard
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The FLS trainer lacks objective and automated assessments of laparoscopic performance and requires a large supply of relatively expensive consumables. Virtual reality simulation has a great potential as a training and assessment tool of laparoscopic skills and can overcome some limitations of the FLS trainer. This study was carried out to assess the value of our Virtual Basic Laparoscopic Surgical Trainer (VBLaST©) in the peg transfer task compared to the FLS trainer and its ability to differentiate performance between novice, intermediate, and expert groups.
Thirty subjects were divided into three groups: novices (PGY1-2, n = 10), intermediates (PGY3-4, n = 10), and experts (PGY5, surgical fellows and attendings, n = 10). All subjects performed ten trials of the peg transfer task on each simulator. Assessment of laparoscopic performance was based on FLS scoring while a questionnaire was used for subjective evaluation.
The performance scores in the two simulators were correlated, though subjects performed significantly better in the FLS trainer. Experts performed better than novices only on the FLS trainer while no significant differences were observed between the other groups. Moreover, a significant learning effect was found on both trainers, with a greater improvement of performance on the VBLaST©. Finally, 82.6 % of the subjects preferred the FLS over the VBLaST© for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the user interface for the VBLaST©.
This study demonstrated that the VBLaST© reproduced faithfully some aspects of the FLS peg transfer task (such as color, size, and shape of the peg board, etc.) while other aspects require additional development. Future improvement of the user interface and haptic feedback will enhance the value of the system as an alternative to the FLS as the standard training tool for laparoscopic surgery skills.
KeywordsSurgical training Virtual reality (VR) Virtual Basic Laparoscopic Surgical Trainer (VBLaST) Fundamentals of Laparoscopic Skills (FLS) Force feedback
This project was supported by the National Institutes of Health (NIH) Grant NIBIB R01 EB010037-01. This work was supported by NIBIB/NIH Grant # R01EB010037.
Dr. Steven D. Schwaitzberg is a consultant for Stryker and Olympus and member of the advisory board for NeatStitch, AcuityBio, MITI, Cambridge Endo and Surgiquest. Dr. Daniel B. Jones is a consultant for Allurion. Likun Zhang, Venkata S. Arikatla, and Drs. Amine Chellali, Ganesh Sankaranarayanan, Woojin Ahn, Alexandre Derevianko, Marc DeMoya, and Caroline G.L. Cao have no conflicts of interest or financial ties to disclose.
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