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Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy

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The pulsatile organ perfusion (POP) trainer provides training of minimally invasive surgery (MIS) with real instruments and cadaveric organs. It provides training of full procedures with simulation of bleeding. Although widely used, the face validity has not yet been evaluated. This study aimed to establish face validity of the POP trainer for laparoscopic cholecystectomy (LC) and its usefulness compared with other training modalities.

Materials and methods

During MIS courses, the participants (n = 52) used the POP trainer to perform LC. Face validity was assessed with questionnaires for realism and usefulness on a five-point Likert scale. Participants were divided into two groups: experts (n = 15) who had performed more than 50 laparoscopic procedures and novices (n = 37) with less than 50 procedures. Secondary aims included the ranking of training modalities, as well as exploration of their specific advantages and disadvantages.


The POP trainer was found to be realistic (3.8 ± 0.9) and useful (4.6 ± 0.9). Differences between experts and novices were only found for “The training modality resembles reality” (3.1 ± 0.8 vs. 3.8 ± 0.7; p = 0.010), “The operation on the POP trainer is realistic” (3.4 ± 1.1 vs. 4.5 ± 0.8; p = 0.003), and “It would be desirable to have a POP trainer at my own hospital” (4.2 ± 1.1 vs. 4.8 ± 0.8; p = 0.040). In the ranking, the animal training (1.1 ± 0.3) placed first, the POP trainer (2.3 ± 0.9) second, and the VR trainer (2.8 ± 0.9) and box trainer (2.8 ± 1.1) third. The realistic simulation of animal training was named as an advantage most often, while the unrealistic simulation of the VR trainer was the most often named disadvantage.


The POP trainer was rated a highly realistic and useful training modality with face validity for LC. Differences between experts and novices existed concerning realism and desirability. Future studies should evaluate the POP trainer for more advanced surgical procedures. The POP trainer widens the spectrum of modalities for training of MIS in a safe environment outside the operating room.

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The current study was performed within the setting of the Collaborative Research Center 125: Cognition Guided Surgery, funded by the German Research Foundation (DFG).


The current study was supported by the Heidelberg Foundation for Surgery.

Authors’ contributions

Müller-Stich, Nickel, Rehberger, Fischer, Linke, and Bintintan were involved in study conception and design; Nickel, Hendrie, Rehberger, Kowalewski, Mayer, Kenngott, and Linke were involved in acquisition of data; Kowalewski and Nickel were involved in statistical analysis; Nickel, Hendrie, Rehberger, Mayer, Kowalewski, Bintintan, Kenngott, Linke, Fischer, and Müller-Stich were involved in analysis and interpretation of data; Nickel, Kowalewski, Hendrie, Kenngott, and Mayer drafted the manuscript; Müller-Stich, Fischer, Linke, and Bintintan were involved in critical revision.

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Correspondence to Beat Peter Müller-Stich.

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Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, and Medtronic. Vasile Bintintan reports receiving speaker fees by KARL STORZ, tutoring fees for courses by Covidien, as well as equipment for laparoscopic surgery courses by Ethicon. Karl-Friedrich Kowalewski, Florian Rehberger, Jonathan David Hendrie, Benjamin Friedrich Berthold Mayer, Hannes Götz Kenngott, Georg Richard Linke, Lars Fischer, and Beat Peter Müller-Stich have no conflicts of interest or financial ties to disclose.

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Nickel, F., Kowalewski, KF., Rehberger, F. et al. Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy. Surg Endosc 31, 714–722 (2017).

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