Comparison of laparoscopic surgical skills acquired on a virtual reality simulator and a box trainer: an analysis for obstetrics-gynecology residents

Abstract

Comparison of laparoscopic surgical skills acquired on a virtual reality simulator and a box trainer: an analysis for obstetrics-gynecology residents M. Varras1,*, C. Loukas2 , N. Nikiteas2 , V.K. Varra3 , F.N. Varra4 , E. Georgiou2 1Fifth Department of Obstetrics and Gynecology, ‘Elena Venizelou’ General Maternity Hospital, Athens (Greece) 2Simulation Center, Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens (Greece) 3Department of Pharmacy, University of Patras (Greece) 4Department of Pharmacy, Frederick University, Nicosia (Cyprus) Summary Background/Aims: It is well known that laparoscopic surgery requires the demonstration of a different set of technical skills when compared to open surgery. Laparoscopic training using simulators has been shown to accelerate learning in an efficient and standardized manner. Significant research has been conducted for skills acquisition in abdominal surgery, but in the field of gynecologic laparoscopy the relevant studies are limited. The aim of this study was to compare the training efficacy of virtual reality (VR) simulators and boxtrainers (BTs) for skills acquisition in gynecologic surgery, and also to study the transferability of these skills in the performance of more advanced gynecologic operations. Methods: Twenty residents in obstetrics-gynecology with minimal laparoscopic experience were randomized into two equal groups to be trained on either a VR simulator (Group-A) or a BT (Group-B). Group-A was trained on basic tasks (clipping, peg transfer, and cutting), whereas Group-B was trained on ovarian cystectomy and salpingotomy using custom training models. After training, the two groups were assessed on the performance of two laparoscopic gynecologic procedures on a VR simulator (salpingotomy and salpingectomy). Performance metrics included time, instrument pathlength, and various task-specific errors. Results: Both groups demonstrated significant performance improvement in all training tasks, for all but one of the metrics (p < 0.05). After training, both groups had improved performance in the laparoscopic operations using the VR simulator, but this trend was not statistically significant in any metric considered (p > 0.05). Similarly, the post-training performance between the two groups was not statistically different (p > 0.05). Conclusions: Basic skills training on either a VR simulator or BT results in equivalent but not statistically significant performance improvement with more advanced gynecologic laparoscopic tasks on a VR simulator. Key words: Virtual reality simulator; Box-trainer; Gynecologic surgical training; Ectopic pregnancy; Salpingotomy; Salpingectomy.