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Comparative Study
. 2013 May;27(5):1721-9.
doi: 10.1007/s00464-012-2664-y. Epub 2012 Dec 14.

Face and construct validation of a virtual peg transfer simulator

Venkata S Arikatla  1 , Ganesh Sankaranarayanan, Woojin Ahn, Amine Chellali, Suvranu De, G L Caroline, John Hwabejire, Marc DeMoya, Steven Schwaitzberg, Daniel B Jones
Affiliations
Comparative Study

Face and construct validation of a virtual peg transfer simulator

Venkata S Arikatla et al. Surg Endosc. 2013 May.

Abstract

Background: The Fundamentals of Laparoscopic Surgery (FLS) trainer box is now established as a standard for evaluating minimally invasive surgical skills. A particularly simple task in this trainer box is the peg transfer task which is aimed at testing the surgeon's bimanual dexterity, hand-eye coordination, speed, and precision. The Virtual Basic Laparoscopic Skill Trainer (VBLaST) is a virtual version of the FLS tasks which allows automatic scoring and real-time, subjective quantification of performance without the need of a human proctor. In this article we report validation studies of the VBLaST peg transfer (VBLaST-PT) simulator.

Methods: Thirty-five subjects with medical background were divided into two groups: experts (PGY 4-5, fellows, and practicing surgeons) and novices (PGY 1-3). The subjects were asked to perform the peg transfer task on both the FLS trainer box and the VBLaST-PT simulator; their performance was evaluated based on established metrics of error and time. A new length of trajectory (LOT) metric has also been introduced for offline analysis. A questionnaire was used to rate the realism of the virtual system on a 5-point Likert scale.

Results: Preliminary face validation of the VBLaST-PT with 34 subjects rated on a 5-point Likert scale questionnaire revealed high scores for all aspects of simulation, with 3.53 being the lowest mean score across all questions. A two-tailed Mann-Whitney test performed on the total scores showed significant (p = 0.001) difference between the groups. A similar test performed on the task time (p = 0.002) and the LOT (p = 0.004) separately showed statistically significant differences between the experts and the novices (p < 0.05). The experts appear to be traversing shorter overall trajectories in less time than the novices.

Conclusion: VBLaST-PT showed both face and construct validity and has promise as a substitute for the FLS for training peg transfer skills.

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Conflict of interest statement

Disclosure

Venkata S Arikatla, Dr. Ganesh Sankaranarayanan, Woojin Ahn, Amine Chellali, John Hwabejire, Marc DeMoya, Steven Schwaitzberg, Daniel B. Jones, Suvranu De and Caroline GL have no conflicts of interest or financial ties to disclose.

Figures

Figure 1
Figure 1
Snapshots of the simulation during various stages of the peg transfer task
Figure 2
Figure 2
(a) Tool interface assembly (b) Close-up of the tool handle with potentiometer
Figure 3
Figure 3
(a) VBLaST-PT© simulator setup (b) subject performing on the VBLaST-PT© module
Figure 4
Figure 4
Plot showing the distribution of subject distribution across experience levels.
Figure 5
Figure 5
Comparison of scores for (a) FLS and (b) VBLaST peg transfer for expert and novice groups. The outliers are shown in circles labeled by the subject number.
Figure 6
Figure 6
Box plot comparing the task time (in sec) for experts and novice groups on (a) FLS and (b) VBLaST. The outliers are shown in circles labeled by the subject number.
Figure 7
Figure 7
Box plot comparing the average LOT (in cm) for expert and novice groups on VBLaST-PT© simulator.
Figure 8
Figure 8
Scatter plot of completion time (in sec) versus average LOT (in cm) for experts and novice groups
See this image and copyright information in PMC

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