A Systematic Review of the Learning Curves of Novices and Trainees to Achieve Proficiency in Laparoscopic Skills: Virtual Reality Simulator Versus Box Trainer

Abstract

Laparoscopic surgery, established in the 1980s, has become a primary treatment method across various surgical specialities due to its advantages over open surgery, including shorter recovery times and fewer complications. Mastery of laparoscopic skills is essential for novice and junior trainees, who must develop hand-eye coordination, depth perception, and instrument handling. This systematic review examines the learning curves of novices using box trainers compared to those using virtual reality (VR) simulators to attain proficiency in laparoscopic skills. The learning curves are assessed through metrics such as the Objective Structured Assessment of Technical Skills (OSATS), the Global Operative Assessment of Laparoscopic Skills (GOALS), and the Global Rating Scale (GRS) based on the time taken to complete specific tasks. A systematic review was conducted to examine the learning curves of novices in achieving proficiency in laparoscopic skills. An extensive literature search on PubMed, Embase, and Cochrane was conducted using keywords like laparoscopic surgery, minimally invasive surgery (MIS), virtual reality (VR), box trainers, and simulation. Thirteen articles were reviewed and analysed in this study. The analysis of data from these papers, along with subsequent meta-analyses, revealed no significant differences in the learning curves of trainees using VR simulators compared to those using box trainers. Variability in conclusions among studies arose from differences in assessment methods and parameters. Overall, there is no consensus on which training modality yields a steeper learning curve. The systematic review and meta-analysis of 13 studies concluded that there was no notable difference in the learning curves of trainees using VR simulators compared to those using box trainers. It suggests the need for standardized assessment methods and parameters across studies. Generally, box trainers are preferred for mastering core laparoscopic skills like knot tying and suturing, while VR simulators are more effective for teaching specific surgical procedures, such as cholecystectomy and hemicolectomy.

Keywords: box trainers; laparoscopic simulator; laparoscopic skills; simulation trainer; virtual reality (vr); virtual reality in medical education.

Figure 1. PRISMA chart.

This systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. AR: augmented reality.

Figure 2. Data collection for risk of bias assessment for the studies included according to the Cochrane Collaboration Risk of Bias tool.

Figure 3. Risk of bias summary.

Figure 4. Forest plot of virtual reality (VR) vs. box trainers (time improvement).

Figure 5. Forest plot of virtual reality (VR) vs. box trainers (score difference and improvement).