A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting

Abstract

Objective: To test whether basic skills acquired on a virtual endoscopic surgery simulator are transferable from virtual reality to physical reality in a comparable training setting.

Summary background data: For surgical training in laparoscopic surgery, new training methods have to be developed that allow surgeons to first practice in a simulated setting before operating on real patients. A virtual endoscopic surgery trainer (VEST) has been developed within the framework of a joint project. Because of principal limitations of simulation techniques, it is essential to know whether training with this simulator is comparable to conventional training.

Methods: Devices used were the VEST system and a conventional video trainer (CVT). Two basic training tasks were constructed identically (a) as virtual tasks and (b) as mechanical models for the CVT. Test persons were divided into 2 groups each consisting of 12 novices and 4 experts. Each group carried out a defined training program over the course of 4 consecutive days on the VEST or the CVT, respectively. To test the transfer of skills, the groups switched devices on the 5th day. The main parameter was task completion time.

Results: The novices in both groups showed similar learning curves. The mean task completion times decreased significantly over the 4 training days of the study. The task completion times for the control task on Day 5 were significantly lower than on Days 1 and 2. The experts' task completion times were much lower than those of the novices.

Conclusions: This study showed that training with a computer simulator, just as with the CVT, resulted in a reproducible training effect. The control task showed that skills learned in virtual reality are transferable to the physical reality of a CVT. The fact that the experts showed little improvement demonstrates that the simulation trains surgeons in basic laparoscopic skills learned in years of practice.

FIGURE 1. (a) The Virtual Endoscopic Surgery Trainer is equipped with 3 force-feedback laparoscopic instruments, camera, and monitor. (b) Conventional Video Trainer with 30° angle camera, instruments, and monitor.

FIGURE 2. Camera tasks (a) Virtual Endoscopic Surgery Trainer (VEST) and (b) Conventional Video Trainer (CVT) and instrument training tasks (c) VEST and (d) CVT are identically constructed.

FIGURE 3. Each group (12 novices and 4 experts) trained for 4 days on the Conventional Video Trainer or the Virtual Endoscopic Surgery Trainer. The groups switched devices on Day 5 to test the transfer of skills.

FIGURE 4. Learning curves of novices and experts for the instrument training over 4 consecutive days (mean ± SEM).

FIGURE 5. Transfer of skills for novices. (a) Training times of the CVT group on 4 consecutive days compared with the VEST group that is training for the first time on the CVT. (b) Training times of the VEST group compared with the CVT group that is training on the VEST (mean ± SD). (c) Errors of the CVT group compared with the VEST group that is training on the CVT (mean ± SD). CVT, Conventional Video Trainer; VEST, Virtual Endoscopic Surgery Trainer. *P < 0.05.