• Cecilie Våpenstad, Erlend Fagertun Hofstad, Lars Eirik Bø, Magdalena Karolina Chmarra, Esther Kuhry, Gjermund Johnsen, Ronald Mårvik, and Thomas Langø.
• Department of Medical Technology, SINTEF Technology and Society, PB 4760, Sluppen, 7465, Trondheim, Norway. cecilie.vapenstad@sintef.no
• Surg Endosc. 2013 Apr 1; 27 (4): 1386-96.

BackgroundSurgeons performing laparoscopy need a high degree of psychomotor skills, which can be trained and assessed on virtual reality (VR) simulators. VR simulators simulate the surgical environment and assess psychomotor skills according to predefined parameters. This study aimed to validate a proficiency-based training setup that consisted of two tasks with predefined threshold values and handles with haptic feedback on the LapSim(®) VR simulator. The two tasks have been found to have construct validity in previous studies using handles without haptic feedback.MethodsThe participants were divided into three groups: novices (0-50 laparoscopic procedures), intermediates (51-300 laparoscopic procedures), and experts (more than 300 procedures). It was assumed that psychomotor skills increase with experience. All participants conducted the tasks lifting and grasping and fine dissection 20 times each. Validity of the training setup was investigated by comparing the number of times each participant passed a predefined threshold level for a set of 19 parameters.ResultsConstruct validity was established for one parameter; "misses on right side" on the lifting and grasping task, whereas the other 18 parameters did not show construct validity.ConclusionThe setup employed in this study failed to establish construct validity for more than one parameter. This indicates that the simulation of haptic feedback influences the training performance on laparoscopic simulators and is an important part of validating a training setup. A haptic device should generate haptic sensations in a realistic manner, without introducing frictional forces that are not inherent to laparoscopy.

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