# Using Virtual Reality Simulators to Enhance Laparoscopic Cholecystectomy Skills Learning
## 4 Discussion  
We found a positive effect of simulation training on achieved global rating scores, as well as operative time, a finding that is aligned with the literature [27, 30, 31, 32, 35, 36, 37]. [PERSON] et al. revealed that all trainees improved their surgical skills irrespective of previous visual-spatial ability (VSA) during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more in [29]. The aim of the study is to determine the overall impact of VRT on laparoscopic surgical performance and to explore whether specific VRT protocols or the addition of feedback confer any advantages for future surgeons. The impact of continuous feedback \begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline  & \multicolumn{2}{c}{**Intervention**} & \multicolumn{2}{c}{**Control**} & \multicolumn{2}{c}{**Mean Difference**} & **Weight** & **Mean Difference** \\ \hline
**Study** & **Mean** & **S.D.** & **N** & **Mean** & **S.D.** & **N** & **IVhet, 95\% CI** & **(\%)** & **IVhet, 95\% CI** \\ \hline OSATS subgroup & & & & & & & & \\ [PERSON] et al. [27] & 8.13 & 1.88 & 20 & 5.13 & 4.13 & 20 & 3.00 [1.01, 4.99] & 8.40 & \\ [PERSON] et al. [34] & 8.33 & 1.67 & 7 & 2.67 & 1.67 & 7 & 5.65 [3.90, 7.41] & 10.76 & \\ [PERSON] et al. (14) [35] & 8.17 & 1.83 & 8 & 4.71 & 3.71 & 8 & 3.47 [0.60, 6.33] & 4.04 & \\ [PERSON] et al. [40] & 7.78 & 2.22 & 9 & 3.57 & 2.57 & 8 & 4.21 [1.91, 6.51] & 6.27 & \\ [PERSON] et al. [42] & 7.27 & 2.73 & 16 & 3.35 & 2.35 & 16 & 3.91 [2.14, 5.68] & 10.60 & \\ Subtotal & & & 60 & & 59 & 4.19 [3.23, 5.15] & 40.07 & \\  & & & & & & & & \\  & & & & & & & & \\  & & & & & & & & \\  & & & & & & & & \\ \hline  & & & & & & & & \\  & & & & & & & & \\ \hline Overall & & & & & & & & & \\  & & & & & & & & \\  & & & & & & & & \\ \hline \hline \end{tabular}
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Table 6: Forest plot for comparing different assessment methods. \begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline  & \multicolumn{2}{c}{**Intervention**} & \multicolumn{2}{c}{**Control**} & \multicolumn{2}{c}{**Mean Difference**} & **Weight** & **Mean Difference** \\ \hline
**Study** & **Mean** & **S.D.** & **N** & **Mean** & **S.D.** & **N** & **IVhet, 95\% CI** & **(\%)** & **IVhet, 95\% CI** \\ \hline iSurgeon subgroup & & & & & & & & \\ [PERSON] et al. [27] & 8.13 & 1.88 & 20 & 5.13 & 4.13 & 20 & 3.00 [1.01, 4.99] & 9.41 & \\ \hline LAP Mentor subgroup & & & & & & & \\ [PERSON] et al. [31] & 5.76 & 4.24 & 33 & 4.00 & 3.00 & 31 & 1.76 [\(-\)0.03, 3.55] & 11.57 & \\ [PERSON] et al. [36] & 7.31 & 2.69 & 107 & 4.71 & 3.70 & 81 & 2.61 [1.66, 3.57] & 40.86 & \\ [PERSON] et al. [39] & 7.27 & 2.73 & 16 & 3.35 & 2.35 & 16 & 3.91 [2.14, 5.68] & 11.88 & \\ Subtotal & & & 156 & & 128 & 2.70 [1.68, 3.72] & 64.30 & \\  & & & & & & & \\  & & & & & & & \\  & & & & & & & \\ \hline LAP Sim subgroup & & & & & & & \\ [PERSON] et al. (14) [35] & 8.17 & 1.83 & 8 & 4.71 & 3.71 & 8 & 3.47 [0.60, 6.33] & 4.52 & \\ [PERSON] et al. (13) [37] & 8.96 & 1.04 & 10 & 3.77 & 2.77 & 10 & 5.19 [3.36, 7.03] & 11.05 & \\ Subtotal & & & & & & & & \\  & & & & & & & & \\  & & & & & & & & \\  & & & & & & & & \\  & & & & & & & \\ \hline  & & & & & & & & \\ \hline \hline  & & & & & & & & \\ \end{tabular}
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Table 7: Forest plot for the scores: VRT systems. on movement parameters during laparoscopic cholecystectomy skills training impacts the acquisition and long-term retention of those skills by surgical novices [47]. Comparing the time to task completion and performance assessment between students vs. residents, we noticed that both types of trainees improved significantly after VRT. It is surprising to find a comparable improvement between students and residents. Due to the extended learning experience in surgery, we anticipate that residents should outperform students using simulation training. The review found similar improvements in both types of trainees.