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An Evidence-Based Virtual Reality Training Program for Novice Laparoscopic Surgeons

Aggarwal, Rajesh MRCS*; Grantcharov, Teodor P. PhD; Eriksen, Jens R. MD; Blirup, Dorthe; Kristiansen, Viggo B. MD; Funch-Jensen, Peter DSc§; Darzi, Ara MD*

doi: 10.1097/01.sla.0000218094.92650.44
Original Articles

Objective: To develop an evidence-based virtual reality laparoscopic training curriculum for novice laparoscopic surgeons to achieve a proficient level of skill prior to participating in live cases.

Summary Background Data: Technical skills for laparoscopic surgery must be acquired within a competency-based curriculum that begins in the surgical skills laboratory. Implementation of this program necessitates the definition of the validity, learning curves and proficiency criteria on the training tool.

Methods: The study recruited 40 surgeons, classified into experienced (performed >100 laparoscopic cholecystectomies) or novice groups (<10 laparoscopic cholecystectomies). Ten novices and 10 experienced surgeons were tested on basic tasks, and 11 novices and 9 experienced surgeons on a procedural module for dissection of Calot triangle. Performance of the 2 groups was assessed using time, error, and economy of movement parameters.

Results: All basic tasks demonstrated construct validity (Mann-Whitney U test, P < 0.05), and learning curves for novices plateaued at a median of 7 repetitions (Friedman's test, P < 0.05). Expert surgeons demonstrated a learning rate at a median of 2 repetitions (P < 0.05). Performance on the dissection module demonstrated significant differences between experts and novices (P < 0.002); learning curves for novice subjects plateaued at the fourth repetition (P < 0.05). Expert benchmark criteria were defined for validated parameters on each task.

Conclusion: A competency-based training curriculum for novice laparoscopic surgeons has been defined. This can serve to ensure that junior trainees have acquired prerequisite levels of skill prior to entering the operating room, and put them directly into practice.

The delivery of a competency-based laparoscopic training program necessitates the use of valid training tools and the definition of preset benchmark criteria. The curriculum charted out in this paper ensures that acquisition of technical skill rather than time spent on each module determines progression along the surgical curriculum.

From the *Department of Surgical Oncology & Technology, Imperial College, London, UK; †Department of Surgical Gastroenterology, Glostrup University Hospital, Glostrup, Denmark; ‡Department of Surgical Gastroenterology, Gentofte University Hospital, Gentofte, Denmark; and §Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.

Reprints: Rajesh Aggarwal, MRCS, Department of Surgical Oncology & Technology, Imperial College London, 10th Floor, Queen Elizabeth the Queen Mother Building, St. Mary's Hospital, Praed Street, London, W2 1NY UK. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.