Innovative dynamic minimally invasive training environment (DynaMITE).

Existing laparoscopic box trainers consist only of static tasks and do not adequately prepare surgeons to navigate the dynamic surgical environment. This paper describes an innovative design using controlled motorized target movements to enhance the training of dynamic motor skills. The prototype was tested using 15 subjects with different surgical experience levels. The task required accurate contact, using a laparoscopic tool, with targets moving in 5 different movement trajectories: (1) static, (2) horizontal, (3) vertical, (4) slow hourglass-shaped, and (5) fast hourglass-shaped. Expert surgeons were significantly faster than novices in the static, horizontal, and slow hourglass target conditions. Intermediate experienced subjects (PGY2s) were faster than novices in the horizontal target condition only. In the fast hourglass condition, experts were not faster than less experienced and novice subjects, but they were more accurate. There is the potential to train hand-eye coordination of even expert surgeons using this dynamic environment.