Training Simulator for Developing Laparoscopic Skills

OBJECTIVE To measure, using objective pre- and posttraining assessments, the degree of improvement in laparoscopic skills following training with a new laparoscopy training simulator (LTS 2000). METHODS This study utilized the LTS 2000 training simulator. The simulator was used in conjunction with a laparoscope joined to a camera, light source, and monitor or with a camcorder. Eleven exercises were planned with tasks designed to develop visual-motor-processing capabilities for referencing the 2-dimensional image of an object on a video screen, and to teach and allow practice of delicate manipulations, circular motions, oviductal cannulation, formation of Roeder loops, and simple suturing and knot-tying. The skill level of individual trainees was assessed before and after training with objective means. Each exercise was assigned a point value of 100 with a maximum score of 1100. Some exercises were scored in number of tasks per 1 minute, others in number of minutes per 1 task. A score of 100 was given for completing a target number of tasks in 1 minute and 0 for not completing any. A score of 100 was given for completing the assigned task in a target amount of time and 0 for not completing it in 3 times that amount. Scores between 100 and 0 were set linearly as a function of those values. RESULTS Of the 11 participating physicians, none scored above the 65th percentile of the maximum achievable score before training; 8 scored above the 73rd percentile after training. The average pretest score was 304.9 points (SD 190.8) range 43.2 to 705.7; posttest score was 834.2 points (SD 141.2) range 547.3 to 1021.7. The average number of hours spent in practice was 5.9 (range 2 to 23). A positive correlation existed between hours of practice and posttest score improvement. CONCLUSION Sustained training with the new simulator resulted in significant improvement in laparoscopic skills in all tested physicians, regardless of prior level of experience.