Construct validity for the LAPSIM laparoscopic surgical simulator

  • A. J. Duffy
  • N. J. Hogle
  • H. McCarthy
  • J. I. Lew
  • A. Egan
  • P. Christos
  • D. L. Fowler
Original article



The skills required for laparoscopic surgery are amenable to simulator-based training. Several computerized devices are now available. We hypothesized that the LAPSIM simulator can be shown to distinguish novice from experienced laparoscopic surgeons, thus establishing construct validity.


We tested residents of all levels and attending laparoscopic surgeons. The subjects were tested on eight software modules. Pass/fail (P/F), time (T), maximum level achieved (MLA), tissue damage (TD), motion, and error scores were compared using the t-test and analysis of variance.


A total of 54 subjects were tested. The most significant difference was found when we compared the most (seven attending surgeons) and least experienced (10 interns) subjects. Grasping showed significance at P/F and MLA (p < 0.03). Clip applying was significant for P/F, MLA, motion, and errors (p < 0.02). Laparoscopic suturing was significant for P/F, MLA, T, TD, as was knot error (p < 0.05). This finding held for novice, intermediate, and expert subjects (p < 0.05) and for suturing time between attending surgeons and residents (postgraduate year [PGY] 1-4) (p < 0.05).


LAPSIM has construct validity to distinguish between expert and novice laparoscopists. Suture simulation can be used to discriminate between individuals at different levels of residency and expert surgeons.


Simulation Construct validity Laparoscopic surgery Resident training Virtual reality LAPSIM Surgical simulator 


  1. 1.
    Anastakis, DJ, Regehr, G, Reznick, RK, Cusimano, M, Murnaghan, J, Brown, M, Hutchison, C 1999Assessment of technical skills transfer from the bench training model to the human modelAm J Surg177167170CrossRefPubMedGoogle Scholar
  2. 2.
    Champion, HR, Gallagher, AG 2003Surgical simulation - a good idea whose time has comeBr J Surg90767768CrossRefPubMedGoogle Scholar
  3. 3.
    Derossis, AM, Antoniuk, M, Fried, GM 1999Evaluation of laparoscopic skills: a 2-year follow-up during residency trainingCan J Surg42293296PubMedGoogle Scholar
  4. 4.
    Feldman, LS, Hagarty, SE, Ghitulescu, G, Stanbridge, D, Fried, GM 2004Relationship between objective assessment of technical skills and subjective in-training evaluations in surgical residentsJ Am Coll Surg198105110CrossRefPubMedGoogle Scholar
  5. 5.
    Feldman, LS, Sherman, V, Fried, GM 2004Using simulators to assess laparoscopic competence: ready for widespread use?Surgery1352842CrossRefPubMedGoogle Scholar
  6. 6.
    Fraser, SA, Klassen, DR, Feldman, LS, Ghitulescu, GA, Stanbridge, D, Fried, GM 2003Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS systemSurg Endosc17964967CrossRefPubMedGoogle Scholar
  7. 7.
    Gallagher, AG, McClure, N, McGuigan, J, Crothers, I, Browning, J 1999Virtual reality training in laparoscopic surgery: a preliminary assessment of Minimally Invasive Surgical Trainer Virtual Reality (MIST VR)Endoscopy31310313CrossRefPubMedGoogle Scholar
  8. 8.
    Gallagher, AG, Ritter, EM, Satava, RM 2003Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and trainingSurg Endosc1715251529CrossRefPubMedGoogle Scholar
  9. 9.
    Gallagher, AG, Cowie, R, Crothers, I, Jordan-Black, JA, Satava, RM 2003PicSOr: an objective test of perceptual skill that predicts laparoscopic technical skill in three initial studies of laparoscopic performanceSurg Endosc1714681471CrossRefPubMedGoogle Scholar
  10. 10.
    Gallagher, AG, Lederman, AB, McGlade, K, Satava, RM, Smith, CD 2004Discriminative validity of the Minimally Invasive Surgical Trainer in Virtual Reality (MIST-VR) using criteria levels based on expert performanceSurg Endosc18660665CrossRefGoogle Scholar
  11. 11.
    Hyltander, A, Liljegren, E, Rhodin, PH, Lonroth, H 2002The transfer of basic skills learned in a laparoscopic simulator to the operating roomSurg Endosc.13241328CrossRefPubMedGoogle Scholar
  12. 12.
    Keyser, EJ, Derossis, AM, Antoniuk, M, Sigman, HH, Fried, GM 2000A simplified simulator for the training and evaluation of laparoscopic skillsSurg Endosc14149153CrossRefPubMedGoogle Scholar
  13. 13.
    Kothari, SN, Kaplan, BJ, DeMaria, EJ, Broderick, TJ, Merrell, RC 2002Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer systemJ Laparoendosc Adv Surg Tech A12167173CrossRefPubMedGoogle Scholar
  14. 14.
    Madan, AK, Frantzides, CT, Shervin, N, Tebbit, CL 2003Assessment of individual hand performance in box trainers compared to virtual reality trainersAm Surg6911121114PubMedGoogle Scholar
  15. 15.
    Munz, Y, Kumar, BD, Moorthy, K, Bann, S, Darzi, A 2004Laparoscopic virtual reality and box trainers: is one superior to the other?Surg Endosc18485494CrossRefPubMedGoogle Scholar
  16. 16.
    Peters, JH, Fried, GM, Swanstrom, LL, Soper, NJ, Sillin, LF, Schirmer, B, Hoffman, K 2004Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgerySurgery1352127CrossRefPubMedGoogle Scholar
  17. 17.
    Ritter, EM, McClusky, DA,III, Lederman, AB, Gallagher, AG, Smith, CD 2003Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulatorJ Gastrointest Surg7871877CrossRefPubMedGoogle Scholar
  18. 18.
    Seymour, NE, Gallagher, AG, Roman, SA, O’Brien, MK, Bansal, VK, Andersen, DK, Satava, RM 2002Virtual reality training improves operating room performance: results of a randomized, double-blinded studyAnn Surg236458463CrossRefPubMedGoogle Scholar
  19. 19.
    Sidhu, RS, Grober, ED, Musselman, LJ, Reznick, RK 2004Assessing competency in surgery: where to begin?Surgery135620CrossRefPubMedGoogle Scholar
  20. 20.
    Strom, P, Kjellin, A, Hedman, L, Johnson, E, Wredmark, T, Fellander-Tsai, L 2003Validation and learning in the Procedicus KSA virtual reality surgical simulatorSurg Endosc17227231CrossRefPubMedGoogle Scholar
  21. 21.
    Villegas, L, Schneider, BE, Gallery, MP, Jones, DB 2003Laparoscopic skills trainingSurg Endosc1718791888CrossRefPubMedGoogle Scholar
  22. 22.
    Wanzel, KR, Ward, M, Reznick, RK 2002Teaching the surgical craft: from selection to certificationCurr Probl Surg39573659PubMedGoogle Scholar
  23. 23.
    Wanzel, KR, Hamstra, SJ, Caminiti, MF, Anastakis, DJ, Grober, ED, Reznick,  2003Visual-spatial ability correlates with efficiency of hand motion and successful surgical performanceSurgery134750757CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • A. J. Duffy
    • 1
  • N. J. Hogle
    • 1
  • H. McCarthy
    • 2
  • J. I. Lew
    • 2
  • A. Egan
    • 1
  • P. Christos
    • 1
  • D. L. Fowler
    • 2
  1. 1.Department of SurgeryMinimal Access Surgery Center, Weill Medical College of Cornell UniversityNew YorkUSA
  2. 2.Department of Surgery Columbia College of Physicians and Surgeons, New York Presbyterian HospitalNew YorkUSA

Personalised recommendations