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LapVR has many modules available, catering to various skill levels. Most basic
are the essential skills, with camera navigation, clip application, cutting, peg trans-
fer, knot tying, and needle-driving exercises, each having several skill levels avail-
able. Trainees can then progress to procedural skills, rehearsing adhesiolysis,
running the bowel, and varying suturing and knot-tying tasks.
Lap VR also has a number of full-length procedures catering to general and
obstetrics/gynecology surgery, such as appendectomy, cholecystectomy, bilateral
tubal occlusion, tubal ectopic pregnancy, and salpingo-oophorectomy. Each proce-
dure has multiple cases available, with and individual patient histories, as well as
notes on procedural perpetration and aftercare.
Once an exercise or case is complete, users can view the results tab. Results
are tailored to the task at hand and are highly detailed. For example, comple-
tion of one of the appendectomy cases will be evaluated based on groupings of
time, proficiency, dexterity, and use of virtual aid. Each of these contains
detailed results. The time header carries information on the duration of the total
procedure and energy application. The proficiency group details cc’s of blood
lost, number of clips placed, length of appendix stump, and adhesion removal,
among others. Dexterity remarks on left- and right-hand path lengths, as well
as errors like excessive force on tissue. Each result is directly compared to an
acceptable score. If the two correlate, the user earns a green check mark adja-
cent to their result. If ever metric has a check, the result is labeled a successful
completion. Reports can be viewed after completion and printed for external
evaluation.
Several studies have demonstrated that virtual reality training translates to
improved laparoscopic skills in the operating room [ 12 – 15 ]. However, the primary
methods of assessment include supervision by trained instructors and documenta-
tion of the time required to perform standardized drills. Supervision by instructors
is an inherently subjective method of assessment. It has also been demonstrated that
time to completion is a poor metric for the objective assessment of laparoscopic task
performance compared to analysis of accuracy [ 6 , 16 ].
While early results suggest that VR simulators and video trainers such as the FLS
have an important role to play in the determination of what constitutes surgical skill
proficiency and how it is to be objectively assessed within training, further valida-
tion of the specific metrics used within these training systems is needed, particularly
with respect to objectivity, and novel objective metrics are needed to enable accu-
rate and reliable assessment of laparoscopic surgical skills training, proficiency, and
decay/retention [ 17 ]. These metrics must demonstrate reliability, validity, practical-
ity, and consistency with measures of high-quality surgery in the operating room in
order to provide the basis for proficiency-based learning programs. [ 5 ] Proficiency-
based training has been shown to result in laparoscopic skills that are durable up to
11 months and retention of such skills was also shown by Hiemstra, Kolkman, Van
de Put, and Jansen (2009) to be durable for up to 1 year for three MIS-related tasks,
similar to FLS tasks [ 18 , 19 ]. However, these studies have relied primarily on sub-
jective metrics for assessment.
E.I. George et al.