# A Review of Training and Guidance Systems in Medical Surgery
## 3 Methods
### Synthesis of the Selected Works
#### 3.8.4 Laparoscopy
This statement can be validated by [PERSON] et al. results, where they found that experienced laparoscopy users slowed down their performance to adapt themselves to new methods or technologies in surgery. On the side of commercial stations that are used to teach novice surgeons specific skills to manipulate surgery stations, the RoSS enables the training of motor and cognitive skills required for operating the da Vinci surgical robot. Simulated Surgical Systems sell it. [PERSON] et al. used this robot-assisted training system to evaluate its capacity to develop cognitive-motor skills [76]. RoSS provides an integrated management system that stores the metrics for all users and tasks performed on this platform. Sixteen modules are programmed into the simulator. For guidance, the simulator provides visual tips on-screen to help students during the task. To evaluate users' performance, bi-manual dexterity, critical errors, safety in the operative field, and task time are considered to provide a score. Scores are generated using a six scale (retake, poor, average, good, expert, and superior). Benefits that RoSS provides to users are customization, and that it is a portable, stand-alone console. Works based on modifications to commercial systems can also be found in laparoscopy. [PERSON] et al. adapted an LS500 laparoscopy surgery simulator with haptic feedback sold by Xitac [77]. The modification was focused on mounting the Lap Mentor training software, developed by Simbionix, into the LS500 system. Lap Mentor consists of two operation modes: skill trainer and procedural training. The skill trainer mode lets users practice fundamental skills in a non-anatomic environment. The second one allows trainees to practice laparoscopic cholecystectomy on a virtual patient. In both modes, the users' level of competence is assessed, and Lap Mentor provides scores for each task. The simulator lets users check videos, 3D maps, and tutorials to enhance their educational process. Lastly, Lap Mentor saves user sessions to provide graphs and performance timelines of students' learning curves. Other work based on modifications to existing environments is the one conducted by [PERSON] et al. [78] The authors adapted the FLS simulator for pediatric purposes. The new approach is called the Pediatric Laparoscopic Surgery (PLS) [119]. PLS is a multi-port box trainer. [PERSON] et al. modified it to be used in a SILS Port, made by Covidien. Four tasks were performed by testers--peg transfer, pattern cutting, lighting loop, and intracorporeal suturing. Using the SILS Port, the PLS can be adapted for low-cost, and low-barrier single-port laparoscopic surgery training. Moreover, on FLS related researches, [PERSON] et al. tested its usefulness by adapting and coupling it in a magnetic resonance (MRI) environment [79]. Tasks in the FLS are evaluated based on speed and accuracy; however, penalty scores are deducted if errors occur in the simulation. In this experiment, [PERSON] et al. replaced all metal parts of the FLS to create an MRI approach. In this test, depth perception, peg transfer, and knot tying on a string were done to assess the user's mental activity. Results pointed brain and behavior relationships during the tasks. This dictates that dynamic changes in cortical networks occur as a consequence of training. This newly implemented FLS application could help educational institutes understand how residents or novices' training evolves and modify or create new educational or courses on laparoscopy. [PERSON] et al. developed a skill assessment and guidance module for a computer-assisted laparoscopic procedures simulator [80]. The authors used the Computer Assisted Surgical Trainer (CAST) developed by [PERSON] et al. [120]. The simulator provides visual and haptic guidance thanks to their previously developed modules [121] which implements virtual fixtures and visual aids. In this study, the authors used an adaptive neuro-fuzzy inference system to assess the user.