Laparoscopic skills are improved with LapMentor training: results of a randomized, double-blinded study

Numerous influences have led to the development of computer-aided simulation to facilitate training in minimally invasive surgery (MIS). These forces include the unique and complex nature of MIS procedures, the requirement for greater efficiency of surgical training due to resident duty hour restrictions and the stringent financial reality of the operating room environment, and most importantly, the legitimate increasing public demand to demonstrate some level of procedural competence prior to performing procedures in the human operating room. Ziv et al have suggested that simulation-based medical education is an ethical imperative, and that the use of simulation in training sends a message that patients are to be protected whenever possible and are not to be used as a convenience of training.1 Simulation-based training has long provided the framework for training in many other complex, high-risk professions (ie, aviation, nuclear power, and the military) with the goal of maximizing safety during training and minimizing risk. It is only recently, however, that simulation has been embraced in the healthcare environment as a possible means of facilitating safer surgical training. Laparoscopic procedures require psychomotor mapping of 3-dimensional space while interacting with a 2-dimensional image. It is this fact combined with the evolution of MIS which has provided the perfect platform and opportunity for the development of computer-aided simulation. Performance of laparoscopic procedures also requires complex psychomotor skills and utilization of optics and instrumentation that are vastly different from those used in conventional open surgery. Additionally, it is far more difficult for the mentor to directly guide the hand of the student and control the course of the laparoscopic procedure, thus often leading to frustration for both learner and instructor. Increasingly, evidence suggests that a well-structured curriculum, which incorporates virtual reality training for laparoscopic surgery, improves performance in both the animate2–6 and human7–10 operating rooms. The majority of these studies, however, have evaluated only 2 of the commercially available laparoscopic simulators (MIST VR™3,6,8,10 or LapSim™2,5), and very few of the other simulators currently on the market have undergone rigorous evaluation and validation. The LapMentor™ (Simbionix USA Corp., Cleveland, OH) is a high-fidelity, computer-aided simulator that provides a laparoscopic training curriculum comprised of basic skills, tutorial procedural tasks, and full procedures (such as laparoscopic cholecystectomy). At the completion of a task or procedure, the simulator provides immediate feedback to the trainee with measures of time, accuracy rate, efficiency of motion, and safety parameters displayed on the screen. The LapMentor™ is also equipped with a high-end technological haptic system, which transmits resistance when tissues or objects are encountered during the simulated task, a feature lacking in many other computer-aided simulators but obviously present in the operating room. While all of these features are highly attractive, the LapMentor™ costs in excess of $100,000, and effective transfer of laparoscopic skills from this simulator to the operating room has not yet been demonstrated. Therefore, the purpose of this study was to determine if training on the LapMentor™ laparoscopic simulator improves resident performance of basic MIS skills in the operating room environment as compared with residents who did not receive any prior training.