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Objectives: As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial., Design: After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training., Setting: All research was performed in the Center for Surgical Technologies, Leuven, Belgium., Participants: In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium)., Results: The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p < 0.01). There were no significant differences between groups at retention testing. The virtual trainer group did not outperform the control group at any time., Conclusions: For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: The LAP Mentor is a procedural simulator that provides a stepwise training for laparoscopic cholecystectomy. This study addresses its "construct" validity that is present when a simulator is able to discriminate between persons with known differences in performance level on the laparoscopic cholecystectomy in real life., Design: Three groups with different skill levels performed 2 trials of 4 distinct parts of the cholecystectomy procedure (cholecystectomy exercises) and 1 full procedure on the LAP Mentor. Assessment parameters concerning the quantity and the quality of performance were compared between groups using the Kruskal-Wallis and Mann-Whitney U tests., Setting: The entire research was performed in the Center for Surgical Technologies, Leuven, Belgium., Participants: For study purposes, 5 expert abdominal laparoscopists (>100 laparoscopic cholecystectomies performed), 11 surgical residents (10-30 cholecystectomies performed), and 10 novices (minimal laparoscopic experience) were recruited., Results: With regard to the quantity of performance (time needed and number of movements), the experts showed significantly better results compared with the novices in the cholecystectomy exercises. Only in the full procedure, the results of all the parameters (except speed) were significantly different between the 3 groups, with the best results observed for the experts and worst for the novices. With respect to quality of performance, only the parameter "accuracy rate of dissection" in exercise 3 showed significantly better performance by the experts., Conclusions: Only the full procedure of the LAP Mentor procedural simulator has enough discriminative power to claim construct validity. However, the lack of quality control, which is indispensible in the evaluation of procedural skills, makes it currently unsuited for the assessment of procedural laparoscopic skills. The role of the simulator in a training context remains to be elucidated., (Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: Surgical interns are often not well prepared and have high anxiety about the execution of basic technical skills. This study investigates whether a short preclinical course focusing on laparoscopic camera-navigating skills is useful in the preparation for internship., Design: Through randomization, an experimental group who attended a short laparoscopic training session and a control group were created. Students' interest for this training and their confidence for laparoscopic exposure during surgical internship were inquired. During internship, camera-navigating skills were assessed by the operating surgeons (using a validated global rating scale) as well as by the students themselves (using a 10-points Likert scale)., Setting: All research was performed in the Center for Surgical Technologies, Leuven, Belgium., Participants: A total of 205 fifth-year medical students at the University of Leuven, Belgium., Results: Of the control group students, 80% were interested in attending the training session. There was no difference in confidence between experimental and control group. According to the surgeons and students, there was a significant improvement in clinical performance from the first (scores on global rating and Likert scales ±50%) to the last procedure (scores ±70%) for both groups. However, there was no difference in performance between groups., Conclusions: Students are very interested in attending a preclinical laparoscopic training session. However, trained students did not display higher confidence or better clinical performance during internship. Even without previous training, students are fast to acquire the necessary skills during surgical internship., (Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate whether preclinical laparoscopy training offers a benefit over standard apprenticeship training and apprenticeship training in combination with simulation training., Design: This randomized controlled trial consisted of 3 groups of first-year surgical registrars receiving a different teaching method in laparoscopic surgery., Setting: The KU LEUVEN Faculty of Medicine is the largest medical faculty in Belgium., Participants: Thirty final-year medical students starting a general surgical career in the next academic year., Methods: Thirty final-year medical students were randomized into 3 groups, which differed in the way they were exposed to laparoscopic simulation training but were comparable in regard to ambidexterity, sex, age, and laparoscopic psychomotoric skills. The control group received only clinical training during surgical residentship, whereas the interval group received clinical training in combination with simulation training. The registrars were allowed to do deliberate practice. The Centre for Surgical Technologies Preclinical Training Programme (CST PTP) group received a preclinical simulation course during the final year as medical students, but was not exposed to any extra simulation training during surgical residentship. At the beginning of surgical residentship and 6 months later, all subjects performed a standardized suturing task and a laparoscopic cholecystectomy in a POP Trainer. All procedures were recorded together with time and motion tracking parameters. All videos were scored by a blinded observer using global rating scales., Results: At baseline the 3 groups were comparable. At 6 months, for suturing, the CST PTP group was better than both the other groups with respect to time, checklist, and amount of movements. The interval group was better than the control group on only the time and checklist score. For the cholecystectomy evaluation, there was a statistical difference between the CST PTP study group and both other groups on all evaluation scales in favor of the CST PTP group., Conclusions: Structured, preclinical proficiency-based training is better than clinical training combined with laboratory training or clinical training alone., (© 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: To determine, given a fixed amount of training, the optimal distribution of sessions needed to acquire intracorporeal endoscopic suturing skills and to retain said skills for 1 to 6 months., Design: A randomized controlled trial consisted of 6 study groups who received identical laparoscopic suturing training but at differing frequencies of sessions., Setting: The faculty of medicine of the KULEUVEN is the largest medical faculty in Belgium., Participants: Medical students without experience in laparoscopy (n = 145)., Methods: After baseline assessments, the students were randomized into 6 groups to receive 6 training sessions of 1.5 hours each. Training Groups were as follows: 3 sessions daily (TD), bidaily sessions, 1 session daily (OD), 1 session on alternative days, 1 session weekly, and 1 session weekly with an optional "deliberate practice" in between sessions (WD). All exercises and feedback given were identical. One and 6 months after the final session, an evaluation was performed where a 5-cm chicken-skin incision had to be closed with 3 laparoscopic knots. The cumulative time to approximate the skin edges adequately was used for qualitative and quantitative analysis., Results: There were no significant differences amongst the groups at baseline concerning ambidexterity, motivation, or spatial abilities. The group OD outperformed the massed groups (TD and bidaily sessions) and the weekly groups (1 session weekly and WD) significantly (p = 0.003). After 1 month there was still a significant advantage for regular training groups (OD, 1 session on alternative days, and WD) over massed training groups (TD) (p = 0.004). After 6 months only a statistical difference (p = 0.04) between group OD and group TD was observed. Group WD's score remained stable after 6 months., Conclusions: Short-term, once daily 1.5-hours session seems most beneficial for learning intracorporeal endoscopic suturing. After 6 months, distributed shorter training still remains better than massed practice but weekly training and daily training are comparable. "Optional Deliberate Practice" between the official training sessions reduces skill decay., (Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)