“…• twenty three papers demonstrating increased development of endoscopic diagnostic and surgical (Tsai and Heinrichs, 1994;Edmond, 2002;Garuda et al, 2002;Seymour et al, 2002;Watterson et al, 2002;Wilhelm et al, 2002;Ahmad et al, 2003;Sedlack et al, 2003Sedlack et al, , 2004Strom et al, 2003;Di Giulio et al, 2004;Grantcharov et al, 2004;Uribe et al, 2004;Clark et al, 2005;Hochberger et al, 2005;Maiss et al, 2005;Matthes et al, 2005;Long and Kalloo, 2006) or other surgical skills, particularly suturing skills, (O'-Toole et al, 1999;Stefanich and CruzNeira, 1999;Summers et al, 1999;Moody et al, 2002;Chaer et al, 2006), achieved by medical students or practitioners through the use of computer based virtual reality, or haptic, endoscopic or other surgical simulators;…”