Skip to main content

Advertisement

Log in

The LapSim virtual reality simulator: promising but not yet proven

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The acquisition of technical skills using surgical simulators is an area of active research and rapidly evolving technology. The LapSim is a virtual reality simulator that currently allows practice of basic laparoscopic skills and some procedures. To date, no reviews have been published with reference to a single virtual reality simulator.

Methods

A PubMed search was performed using the keyword “LapSim,” with further papers identified from the citations of original search articles.

Results

Use of the LapSim to develop surgical skills has yielded overall results, although inconsistencies exist. Data regarding the transferability of learned skills to the operative environment are encouraging as is the validation work, particularly the use of a combination of measured parameters to produce an overall comparative performance score.

Conclusion

Although the LapSim currently does not have any proven significant advantages over video trainers in terms of basic skills instruction and although the results of validation studies are variable, the potential for such technology to have a huge impact on surgical training is apparent. Work to determine standardized learning curves and proficiency criteria for different levels of trainees is incomplete. Moreover, defining which performance parameters measured by the LapSim accurately determine laparoscopic skill is complex. Further technological advances will undoubtedly improve the efficacy of the LapSim, and the results of large multicenter trials are anticipated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. The Intercollegiate Surgical Curriculum Project. http://www.iscp.ac.uk. Retrieved 17 September 2009

  2. Soper NJ, Fried GM (2008) The fundamentals of laparoscopic surgery: its time has come. Bull Am Coll Surg 93:30–32

    PubMed  Google Scholar 

  3. Gurusamy KS, Aggarwal R, Palanivelu L, Davidson BR (2009) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev CD006575

  4. Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, Jakimowicz JJ (2005) Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19:1523–1532

    Article  CAS  PubMed  Google Scholar 

  5. Sutherland LM, Middleton PF, Anthony A, Hamdorf J, Cregan P, Scott D, Maddern GJ (2006) Surgical simulation: a systematic review. Ann Surg 243:291–300

    Article  PubMed  Google Scholar 

  6. van der Meijden OA, Schijven MP (2009) The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc 23:1180–1190

    Article  PubMed  Google Scholar 

  7. Tsuda S, Scott D, Doyle J, Jones DB (2009) Surgical skills training and simulation. Curr Probl Surg 46:271–370

    Article  PubMed  Google Scholar 

  8. Sturm LP, Windsor JA, Cosman PH, Cregan P, Hewett PJ, Maddern GJ (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248:166–179

    Article  PubMed  Google Scholar 

  9. SurgicalScience. http://www.surgical-science.com. Retrieved 8 September 2009

  10. Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, Schroeder TV, Ottesen BS (2009) Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 338:b1802

    Article  PubMed  Google Scholar 

  11. Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA III, Ramel S, Smith CD, Arvidsson D (2007) Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193:797–804

    Article  PubMed  Google Scholar 

  12. Cosman PH, Hugh TJ, Shearer CJ, Merrett ND, Biankin AV, Cartmill JA (2007) Skills acquired on virtual reality laparoscopic simulators transfer into the operating room in a blinded, randomised, controlled trial. Stud Health Technol Inform 125:76–81

    CAS  PubMed  Google Scholar 

  13. Hyltander A, Liljegren E, Rhodin PH, Lonroth H (2002) The transfer of basic skills learned in a laparoscopic simulator to the operating room. Surg Endosc 16:1324–1328

    Article  CAS  PubMed  Google Scholar 

  14. Youngblood PL, Srivastava S, Curet M, Heinrichs WL, Dev P, Wren SM (2005) Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance. J Am Coll Surg 200:546–551

    Article  PubMed  Google Scholar 

  15. SimuLab Corporation. http://www.simulab.com/product/surgery/laparoscopic/tower-trainer. Retrieved 15 September 2009

  16. Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc 18:485–494

    Article  CAS  PubMed  Google Scholar 

  17. Newmark J, Dandolu V, Milner R, Grewal H, Harbison S, Hernandez E (2007) Correlating virtual reality and box trainer tasks in the assessment of laparoscopic surgical skills. Am J Obstet Gynecol 197:546e1–546e4

    Article  Google Scholar 

  18. Munz Y, Almoudaris AM, Moorthy K, Dosis A, Liddle AD, Darzi AW (2007) Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality. Am J Surg 193:774–783

    Article  PubMed  Google Scholar 

  19. Mentice. http://www.mentice.com. Retrieved 15 September 2009

  20. Hogle NJ, Widmann WD, Ude AO, Hardy MA, Fowler DL (2008) Does training novices to criteria and does rapid acquisition of skills on laparoscopic simulators have predictive validity or are we just playing video games? J Surg Educ 65:431–435

    Article  PubMed  Google Scholar 

  21. Hogle NJ, Chang L, Strong VE, Welcome AO, Sinaan M, Bailey R, Fowler DL (2009) Validation of laparoscopic surgical skills training outside the operating room: a long road. Surg Endosc 23:1476–1482

    Article  CAS  PubMed  Google Scholar 

  22. Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondre K, Stanbridge D, Fried GM (2005) A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 190:107–113

    Article  PubMed  Google Scholar 

  23. Botden SM, Buzink SN, Schijven MP, Jakimowicz JJ (2007) Augmented versus virtual reality laparoscopic simulation: what is the difference? A comparison of the ProMIS augmented reality laparoscopic simulator versus LapSim virtual reality laparoscopic simulator. World J Surg 31:764–772

    Article  PubMed  Google Scholar 

  24. Pellen MG, Horgan LF, Barton JR, Attwood SE (2009) Construct validity of the ProMIS laparoscopic simulator. Surg Endosc 23:130–139

    Article  PubMed  Google Scholar 

  25. Pellen M, Horgan L, Roger Barton J, Attwood S (2009) Laparoscopic surgical skills assessment: can simulators replace experts? World J Surg 33:440–447

    Article  PubMed  Google Scholar 

  26. Aggarwal R, Grantcharov TP, Eriksen JR, Blirup D, Kristiansen VB, Funch-Jensen P, Darzi A (2006) An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 244:310–314

    Article  PubMed  Google Scholar 

  27. Duffy AJ, Hogle NJ, McCarthy H, Lew JI, Egan A, Christos P, Fowler DL (2005) Construct validity for the LapSim laparoscopic surgical simulator. Surg Endosc 19:401–405

    Article  CAS  PubMed  Google Scholar 

  28. Eriksen JR, Grantcharov T (2005) Objective assessment of laparoscopic skills using a virtual reality stimulator. Surg Endosc 19:1216–1219

    Article  CAS  PubMed  Google Scholar 

  29. Hassan I, Sitter H, Schlosser K, Zielke A, Rothmund M, Gerdes B (2005) A virtual reality simulator for objective assessment of surgeons’ laparoscopic skill. Chirurg 76:151–156

    Article  CAS  PubMed  Google Scholar 

  30. Langelotz C, Kilian M, Paul C, Schwenk W (2005) LapSim virtual reality laparoscopic simulator reflects clinical experience in German surgeons. Langenbecks Arch Surg 390:534–537

    Article  CAS  PubMed  Google Scholar 

  31. Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sorensen JL, Dalsgaard T, Ottesen B (2006) Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc 20:1460–1466

    Article  CAS  PubMed  Google Scholar 

  32. Sherman V, Feldman LS, Stanbridge D, Kazmi R, Fried GM (2005) Assessing the learning curve for the acquisition of laparoscopic skills on a virtual reality simulator. Surg Endosc 19:678–682

    Article  CAS  PubMed  Google Scholar 

  33. van Dongen KW, Tournoij E, van der Zee DC, Schijven MP, Broeders IA (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21:1413–1417

    Article  PubMed  Google Scholar 

  34. Woodrum DT, Andreatta PB, Yellamanchilli RK, Feryus L, Gauger PG, Minter RM (2006) Construct validity of the LapSim laparoscopic surgical simulator. Am J Surg 191:28–32

    Article  PubMed  Google Scholar 

  35. Danila R, Gerdes B, Ulrike H, Dominguez Fernandez E, Hassan I (2009) Objective evaluation of minimally invasive surgical skills for transplantation: surgeons using a virtual reality simulator. Chirurgia Bucur 104:181–185

    CAS  PubMed  Google Scholar 

  36. Panait L, Bell RL, Roberts KE, Duffy AJ (2008) Designing and validating a customized virtual reality-based laparoscopic skills curriculum. J Surg Educ 65:413–417

    Article  PubMed  Google Scholar 

  37. Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A (2007) Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 246:771–779

    Article  PubMed  Google Scholar 

  38. Dosis A, Aggarwal R, Bello F, Moorthy K, Munz Y, Gillies D, Darzi A (2005) Synchronized video and motion analysis for the assessment of procedures in the operating theater. Arch Surg 140:293–299

    Article  PubMed  Google Scholar 

  39. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, Brown M (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273–278

    Article  CAS  PubMed  Google Scholar 

  40. Hassan I, Maschuw K, Rothmund M, Koller M, Gerdes B (2006) Novices in surgery are the target group of a virtual reality training laboratory. Eur Surg Res 38:109–113

    Article  PubMed  Google Scholar 

  41. Ro CY, Toumpoulis IK, Ashton RC Jr, Jebara T, Schulman C, Todd GJ, Derose JJ Jr, McGinty JJ (2005) The LapSim: a learning environment for both experts and novices. Stud Health Technol Inform 111:414–417

    PubMed  Google Scholar 

  42. Hassan I, Koller M, Zielke A, Lehmann K, Rothmund M, Gerdes B (2006) Improvement of surgical skills after a three-day practical course for laparoscopic surgery. Swiss Med Wkly 136:631–636

    PubMed  Google Scholar 

  43. Hassan I, Gerdes B, Koller M, Langer P, Rothmund M, Zielke A (2006) Clinical background is required for optimum performance with a VR laparoscopy simulator. Comput Aided Surg 11:103–106

    Article  CAS  PubMed  Google Scholar 

  44. Panait L, Rafiq A, Tomulescu V, Boanca C, Popescu I, Carbonell A, Merrell RC (2006) Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc 20:113–118

    Article  CAS  PubMed  Google Scholar 

  45. Royal Australasian College of Surgeons. http://www.surgeons.org/content/NavigationMenu/EducationandTraining/Training/Standardsandprotocols/Assessment/default.htm. Retrieved 12 September 2009

  46. Kundhal PS, Grantcharov TP (2009) Psychomotor performance measured in a virtual environment correlates with technical skills in the operating room. Surg Endosc 23:645–649

    Article  PubMed  Google Scholar 

  47. Tomulescu V, Popescu I (2004) The use of LapSim virtual reality simulator in the evaluation of laparoscopic surgery skill: preliminary results. Chirurgia Bucur 99:523–527

    CAS  PubMed  Google Scholar 

  48. Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150

    Article  CAS  PubMed  Google Scholar 

  49. Faulkner H, Regehr G, Martin J, Reznick R (1996) Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 71:1363–1365

    Article  CAS  PubMed  Google Scholar 

  50. Hogle NJ, Briggs WM, Fowler DL (2007) Documenting a learning curve and test–retest reliability of two tasks on a virtual reality training simulator in laparoscopic surgery. J Surg Educ 64:424–430

    Article  PubMed  Google Scholar 

  51. Schlosser K, Alkhawaga M, Maschuw K, Zielke A, Mauner E, Hassan I (2007) Training of laparoscopic skills with virtual reality simulator:a critical reappraisal of the learning curve. Eur Surg 39:180–184

    Article  Google Scholar 

  52. Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A, Darzi A (2006) Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 113:1382–1387

    Article  CAS  PubMed  Google Scholar 

  53. Sinha P, Hogle NJ, Fowler DL (2008) Do the laparoscopic skills of trainees deteriorate over time? Surg Endosc 22:2018–2025

    Article  PubMed  Google Scholar 

  54. Salgado J, Grantcharov TP, Papasavas PK, Gagne DJ, Caushaj PF (2009) Technical skills assessment as part of the selection process for a fellowship in minimally invasive surgery. Surg Endosc 23:641–644

    Article  PubMed  Google Scholar 

  55. Darzi A, Smith S, Taffinder N (1999) Assessing operative skill: needs to become more objective. BMJ 318:887–888

    CAS  PubMed  Google Scholar 

  56. Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, Zielke A (2006) Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg 93:1554–1559

    Article  CAS  PubMed  Google Scholar 

  57. Schuetz M, Gockel I, Beardi J, Hakman P, Dunschede F, Moenk S, Heinrichs W, Junginger T (2008) Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario. Surg Endosc 22:1263–1267

    Article  CAS  PubMed  Google Scholar 

  58. Maschuw K, Osei-Agyemang T, Weyers P, Danila R, Bin Dayne K, Rothmund M, Hassan I (2008) The impact of self-belief on laparoscopic performance of novices and experienced surgeons. World J Surg 32:1911–1916

    Article  CAS  PubMed  Google Scholar 

  59. Hassan I, Gerdes B, Koller M, Dick B, Hellwig D, Rothmund M, Zielke A (2007) Spatial perception predicts laparoscopic skills on virtual reality laparoscopy simulator. Childs Nerv Syst 23:685–689

    Article  CAS  PubMed  Google Scholar 

  60. Amercian College of Surgeons. http://www.facs.org/education/surgicalskills.html. Retrieved 18 September 2009

Download references

Disclosures

Katherine Fairhurst, Andrew Strickland, and Guy Maddern have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Guy Maddern.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fairhurst, K., Strickland, A. & Maddern, G. The LapSim virtual reality simulator: promising but not yet proven. Surg Endosc 25, 343–355 (2011). https://doi.org/10.1007/s00464-010-1181-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1181-0

Keywords

Navigation