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Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers

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The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers.


Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1-4). They were asked to perform the PC or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared.


There were no significant differences between the FLS and VBLaST© scores for either the PC or the ligating loop task. Experts’ scores were significantly higher than the scores for novices on both trainers.


This study showed that the subjects’ performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Although concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.

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This project was supported by National Institutes of Health (NIH) Grant NIBIB R01 EB010037-01. This research was conducted in collaboration with the SAGES FLS Committee.


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. Jeff Flinn and Drs. Amine Chellali, Woojin Ahn, Ganesh Sankaranarayanan, Daniel B. Jones, Suvranu De, and Caroline, G.L. Cao have no conflicts of interest or financial ties to disclose.

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Correspondence to C. G. L. Cao.

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Presented as an oral presentation at the SAGES 2014 annual meeting.

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Chellali, A., Ahn, W., Sankaranarayanan, G. et al. Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers. Surg Endosc 29, 815–821 (2015).

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