Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies - 22/08/11

Doi : 10.1016/j.amjsurg.2006.06.050

Gunnar Ahlberg, M.D., Ph.D. ^a,^b,^⁎ , Lars Enochsson, M.D., Ph.D. ^c,^d, Anthony G. Gallagher, Ph.D. ^f, Leif Hedman, Ph.D. ^d, Christian Hogman, M.Sc. ^b, David A. McClusky, M.D. ^e, Stig Ramel, M.D., Ph.D. ^a, C. Daniel Smith, M.D., F.A.C.S. ^g, Dag Arvidsson, M.D., Ph.D. ^c
^a Department of Surgery, Karolinska University Hospital, SE-171 76, Sweden
^b Center for Advanced Medical Simulation, Karolinska University Hospital, SE-171 76, Sweden
^c Department of Surgery, Karolinska University Hospital, SE-141 52, Huddinge, Sweden
^d Center for Advanced Medical Simulation, Karolinska University Hospital, SE-141 52, Huddinge, Sweden
^e Department of Surgery, Emory University, Atlanta, GA 30322, USA
^f Department of Psychology, Queens University, University Road, Belfast BT7 1NN, Northern Ireland, United Kingdom
^g Emory Endosurgery Unit, Emory University School of Medicine, Atlanta, GA 30322, USA

Corresponding author. Tel.: +468-517-796-26; fax: +468-33-15-87.

Abstract

Background

Virtual reality (VR) training has been shown previously to improve intraoperative performance during part of a laparoscopic cholecystectomy. The aim of this study was to assess the effect of proficiency-based VR training on the outcome of the first 10 entire cholecystectomies performed by novices.

Methods

Thirteen laparoscopically inexperienced residents were randomized to either (1) VR training until a predefined expert level of performance was reached, or (2) the control group. Videotapes of each resident’s first 10 procedures were reviewed independently in a blinded fashion and scored for predefined errors.

Results

The VR-trained group consistently made significantly fewer errors (P = .0037). On the other hand, residents in the control group made, on average, 3 times as many errors and used 58% longer surgical time.

Conclusions

The results of this study show that training on the VR simulator to a level of proficiency significantly improves intraoperative performance during a resident’s first 10 laparoscopic cholecystectomies.

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Keywords : Virtual reality, Proficiency-based, Training, Simulation, Laparoscopic