Training Simulator for Developing Laparoscopic Skills

OBJECTIVE: To measure, using objective pre- and post-training 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.