Face and construct validation of a virtual peg transfer simulator

Arikatla, Venkata Sreekanth; Sankaranarayanan, Ganesh; Ahn, Woojin; Chellali, Amine; De, Suvranu; Caroline, G. L.; Hwabejire, John O.; DeMoya, Marc; Schwaitzberg, Steven D.; Jones, Daniel B.

doi:10.1007/s00464-012-2664-y

Cited by 34 publications

(39 citation statements)

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“…According to the results, all participants agreed with the usefulness and degree of difficulty that presented of the tasks selected for this study. In our study, the four skill tasks were chosen for two main reasons: (1) these tasks are well validated in many clinical studies [35][36][37][38][39][40][41], and (2) they contain laparoscopic skills and techniques that are usually present in many laparoscopic procedures…”

Section: Discussionmentioning

confidence: 99%

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

et al. 2014

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Background The aim of this study is to present face, content, and constructs validity of the endoscopic orthogonal video system (EndoViS) training system and determines its efficiency as a training and objective assessment tool of the surgeons' psychomotor skills. Methods Thirty-five surgeons and medical students participated in this study: 11 medical students, 19 residents, and 5 experts. All participants performed four basic skill tasks using conventional laparoscopic instruments and EndoViS training system. Subsequently, participants filled out a questionnaire regarding the design, realism, overall functionality, and its capabilities to train hand-eye coordination and depth perception, rated on a 5-point Likert scale. Motion data of the instruments were obtained by means of two webcams built into a laparoscopic physical trainer. To identify the surgical instruments in the images, colored markers were placed in each instrument. Thirteen motion-related metrics were used to assess laparoscopic performance of the participants. Statistical analysis of Flores • performance was made between novice, intermediate, and expert groups. Internal consistency of all metrics was analyzed with Cronbach's a test.Results Overall scores about features of the EndoViS system were positives. Participants agreed with the usefulness of tasks and the training capacities of EndoViS system (score >4). Results presented significant differences in the execution of three skill tasks performed by participants. Seven metrics showed construct validity for assessment of performance with high consistency levels. Conclusions EndoViS training system has been successfully validated. Results showed that EndoViS was able to differentiate between participants of varying laparoscopic experience. This simulator is a useful and effective tool to objectively assess laparoscopic psychomotor skills of the surgeons. Keywords Laparoscopic surgery • Surgical training • Objective assessment • Motion metrics • Validation • Endoscopic orthogonal video system (EndoViS)Laparoscopic surgery has become an important technique within several surgical specialties, such as general surgery, gynecology, and urology. This minimally invasive technique offers many benefits for the patients as less postoperative pain, better cosmetics results, and shorter periods of hospitalization [1][2][3]. Laparoscopic surgery, however, demands additional psychomotor abilities and skills different from those in conventional open surgery [4,5].Traditionally, surgical residents acquire minimally invasive skills based on the classic apprenticeship model with hands-on training in the operation room [6,7]. This training method is not efficient, prolongs the learning curve of surgeons, and represents a potential risk to patient safety. Due to concerns for medical safety, it is essential the development of training methods for safe practice of laparoscopic surgery outside of the operating theater with the additional assessment of the surgical skills of surgeons.Currently, laparoscopic sur...

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Section: Discussionmentioning

confidence: 99%

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

et al. 2014

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“…However, some of these systems lack realistic haptic feedback, are costly, or have not been validated for training of laparoscopic skills (e.g. Lap-X) [21, 22, 23, 24]. …”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the system provides haptic feedback to the user through a haptic device. The VBLaST © simulating the peg transfer task of the FLS trainer has been previously validated [24, 25]. In this study, two new tasks of the VBLaST © system, namely, the pattern cutting (PC) task and the ligating loop (LL) task, are evaluated.…”

Section: Introductionmentioning

confidence: 99%

Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers

Chellali

Ahn²,

Sankaranarayanan³

et al. 2014

Surg Endosc

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Introduction The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers. Methods Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1–4). They were asked to perform the pattern cutting or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared. Results There were no significant differences between the FLS and VBLaST© scores for either the pattern cutting or the ligating loop task. Experts’ scores were significantly higher than the scores for novices on both trainers. Conclusion This study showed that the subjects’ performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Though concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.

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“…The VBLaST© provides haptic feedback to aid learning, objective and automated measurements of performance, and repeated training with no need to replenish materials. VBLaST-PT© [24], the system used for this study, is a subset of the VBLaST© simulator that simulates the peg transfer task of the FLS system, which has undergone face and convergent validation [25, 26]. …”

Section: Introductionmentioning

confidence: 99%

Validation of the VBLaST peg transfer task: a first step toward an alternate training standard

et al. 2014

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Background The FLS trainer lacks objective and automated assessments of laparoscopic performance and requires a large supply of relatively expensive consumables. Virtual reality simulation has a great potential as a training and assessment tool of laparoscopic skills and can overcome some limitations of the FLS trainer. This study was carried out to assess the value of our Virtual Basic Laparoscopic Surgical Trainer (VBLaST©) in the peg transfer task compared to the FLS trainer and its ability to differentiate performance between novice, intermediate and expert groups. Methods Thirty subjects were divided into three groups: novices (PGY1-2, n = 10), intermediates (PGY3-4, n=10), and experts (PGY5, surgical fellows and attendings, n = 10). All subjects performed ten trials of the peg transfer task on each simulator. Assessment of laparoscopic performance was based on FLS scoring while a questionnaire was used for subjective evaluation. Results The performance scores in the two simulators were correlated, though subjects performed significantly better in the FLS trainer. Experts performed better than novices only on the FLS trainer while no significant differences were observed between the other groups. Moreover, a significant learning effect was found on both trainers, with a greater improvement of performance on the VBLaST©. Finally, 82.6% of the subjects preferred the FLS over the VBLaST© for surgical training which could be attributed to the novelty of the VR technology and existing deficiencies of the user interface for the VBLaST©. Conclusion This study demonstrated that the VBLaST© reproduced faithfully some aspects of the FLS peg transfer task (such as color, size and shape of the peg board, etc.) while other aspects require additional development. Future improvement of the user interface and haptic feedback will enhance the value of the system as an alternative to the FLS as the standard training tool for laparoscopic surgery skills.

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Face and construct validation of a virtual peg transfer simulator

Cited by 34 publications

References 20 publications

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

Face, content, and construct validity of the EndoViS training system for objective assessment of psychomotor skills of laparoscopic surgeons

Preliminary evaluation of the pattern cutting and the ligating loop virtual laparoscopic trainers

Validation of the VBLaST peg transfer task: a first step toward an alternate training standard

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