Validation of a virtual intracorporeal suturing simulator

  • Yaoyu Fu
  • Lora CavuotoEmail author
  • Di Qi
  • Karthikeyan Panneerselvam
  • Gene Yang
  • Venkata Sreekanth Artikala
  • Andinet Enquobahrie
  • Suvranu De
  • Steven D. Schwaitzberg



Intracorporeal suturing is one of the most important and difficult procedures in laparoscopic surgery. Practicing on a FLS trainer box is effective but requires large number of consumables, and the scoring is somewhat subjective and not immediate. A virtualbasic laparoscopic skill trainer (VBLaST©) was developed to simulate the five tasks of the FLS Trainer Box. The purpose of this study is to evaluate the face and content validity of the VBLaST suturing simulator (VBLaST-SS©).


Twenty-five medical students and residents completed an evaluation of the simulator. The participants were asked to perform the standard intracorporeal suturing task on both VBLaST-SS© and the traditional FLS box trainer. The performance scores on each system were calculated based on time (s), deviations to the black dots (mm), and incision gap (mm). The participants were then asked to finish a 13-item questionnaire with ratings from 1 (not realistic/useful) to 5 (very realistic/useful) regarding the face validity of the simulator. A Wilcoxon signed rank test was performed to identify differences in performance on the VBLaST-SS© compared to that of the traditional FLS box trainer.


Three questions from the face validity questionnaire were excluded due to lack of response. Ratings to 8 of the remaining 10 questions (80%) averaged above 3.0 out of 5. Average intracorporeal suturing completion time on the VBLaST-SS© was 421 (SD = 168 s) seconds compared to 406 (175 s) seconds on the box trainer (p = 0.620). There was a significant difference between systems for the incision gap (p = 0.048). Deviation in needle insertion from the black dot was smaller for the box trainer than the virtual simulator (1.68 vs. 7.12, p < 0.001).


Participants showed comparable performance on the VBLaST-SS© and traditional box trainer. Overall, the VBLaST-SS© system showed face validity and has the potential to support training for the suturing skills.


Virtual reality Suturing simulation The Fundamentals of Laparoscopic Surgery (FLS) Intracorporeal suturing Face validity 



This work was supported by the NIBIB/NIH Grant #5R44EB019802.

Compliance with ethical standards


Yaoyu Fu and Drs. Lora Cavuoto, Di Qi, Karthikeyan Panneerselvam, Gene Yang, Venkata Sreekanth Artikala, Andinet Enquobahrie, Suvranu De have no conflicts of interest or financial ties to disclose. Dr Schwaitzberg has no relevant conflicts related to this manuscript and is a consultant for Activ Surgical, Human Extensions, Arch Therapeutics, Acuitiy Bio, and Nu View Surgical.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Yaoyu Fu
    • 1
  • Lora Cavuoto
    • 1
    Email author
  • Di Qi
    • 2
  • Karthikeyan Panneerselvam
    • 2
  • Gene Yang
    • 4
  • Venkata Sreekanth Artikala
    • 3
  • Andinet Enquobahrie
    • 3
  • Suvranu De
    • 2
  • Steven D. Schwaitzberg
    • 4
  1. 1.Department of Industrial and Systems EngineeringUniversity at BuffaloBuffaloUSA
  2. 2.Center for Modeling, Simulation and Imaging in Medicine (CeMSIM)Rensselaer Polytechnic InstituteTroyUSA
  3. 3.Medical Computing GroupKitware, Inc.CarrboroUSA
  4. 4.Department of SurgeryUniversity at BuffaloBuffaloUSA

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