All the available experimental tools, including virtual environments, in vitro trainers, and analysis of in vivo performance, will be necessary to better understand the factors that underlie surgical performance. Below we will describe briefly some of the ways we plan to use virtual environments to study perceptual motor skills, spatial skills, and critical steps of procedures. Simultaneously, we will discuss the parallel issues of how to train these skills and validate training effectiveness. Some skills, most notably laparoscopic suturing and knot tying, are complex tasks that must be explicitly trained. Other important skills are harder to define, and appear to depend on spatial cognitive ability.
Proper exposure is essential in any operation.
The surgeon must orient the tissues for good vision and access, place the laparoscope to obtain an adequate view, and apply traction on tissues in a way that facilitates dissection. An inexperienced surgeon struggling as he performs a procedure will often find it far simpler after an expert makes only a few adjustments of the camera and instruments that provide better exposure. Exposure skills appear to be predominantly spatial, rather than perceptual-motor. Spatial skills or abilities involve the representation, storage and processing of knowledge of the spatial properties of objects, such as location, movement, extent, shape and connectivity. There are large individual differences in spatial abilities.