Virtual reality simulator training for laparoscopic colectomy: what metrics have construct validity? 2014

Skandan Shanmugan, and Fabien Leblanc, and Anthony J Senagore, and C Neal Ellis, and Sharon L Stein, and Sadaf Khan, and Conor P Delaney, and Bradley J Champagne
1Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, Ohio 2Department of Digestive Surgery, University Hospitals of Bordeaux, Bordeaux, France 3Division of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 4Division of Colorectal Surgery, Veterans Administration Gulf Coast Veterans Health Care System, Biloxi, Mississippi.

BACKGROUND Virtual reality simulation for laparoscopic colectomy has been used for training of surgical residents and has been considered as a model for technical skills assessment of board-eligible colorectal surgeons. However, construct validity (the ability to distinguish between skill levels) must be confirmed before widespread implementation. OBJECTIVE This study was designed to specifically determine which metrics for laparoscopic sigmoid colectomy have evidence of construct validity. METHODS General surgeons that had performed fewer than 30 laparoscopic colon resections and laparoscopic colorectal experts (>200 laparoscopic colon resections) performed laparoscopic sigmoid colectomy on the LAP Mentor model. All participants received a 15-minute instructional warm-up and had never used the simulator before the study. Performance was then compared between each group for 21 metrics (procedural, 14; intraoperative errors, 7) to determine specifically which measurements demonstrate construct validity. Performance was compared with the Mann-Whitney U-test (p < 0.05 was significant). RESULTS Fifty-three surgeons; 29 general surgeons, and 24 colorectal surgeons enrolled in the study. The virtual reality simulators for laparoscopic sigmoid colectomy demonstrated construct validity for 8 of 14 procedural metrics by distinguishing levels of surgical experience (p < 0.05). The most discriminatory procedural metrics (p < 0.01) favoring experts were reduced instrument path length, accuracy of the peritoneal/medial mobilization, and dissection of the inferior mesenteric artery. Intraoperative errors were not discriminatory for most metrics and favored general surgeons for colonic wall injury (general surgeons, 0.7; colorectal surgeons, 3.5; p = 0.045). CONCLUSIONS Individual variability within the general surgeon and colorectal surgeon groups was not accounted for. CONCLUSIONS The virtual reality simulators for laparoscopic sigmoid colectomy demonstrated construct validity for 8 procedure-specific metrics. However, using virtual reality simulator metrics to detect intraoperative errors did not discriminate between groups. If the virtual reality simulator continues to be used for the technical assessment of trainees and board-eligible surgeons, the evaluation of performance should be limited to procedural metrics.

UI MeSH Term Description Entries
D009048 Motor Skills Performance of complex motor acts. Motor Skill,Skill, Motor,Skills, Motor
D010535 Laparoscopy A procedure in which a laparoscope (LAPAROSCOPES) is inserted through a small incision near the navel to examine the abdominal and pelvic organs in the PERITONEAL CAVITY. If appropriate, biopsy or surgery can be performed during laparoscopy. Celioscopy,Laparoscopic Surgical Procedures,Peritoneoscopy,Surgical Procedures, Laparoscopic,Laparoscopic Assisted Surgery,Laparoscopic Surgery,Laparoscopic Surgical Procedure,Procedure, Laparoscopic Surgical,Procedures, Laparoscopic Surgical,Surgery, Laparoscopic,Surgical Procedure, Laparoscopic,Celioscopies,Laparoscopic Assisted Surgeries,Laparoscopic Surgeries,Laparoscopies,Peritoneoscopies,Surgeries, Laparoscopic,Surgeries, Laparoscopic Assisted,Surgery, Laparoscopic Assisted
D002983 Clinical Competence The capability to perform acceptably those duties directly related to patient care. Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D003082 Colectomy Surgical resection of a portion of or the entire colon. Hemicolectomy,Large Bowel Resection,Colectomies,Hemicolectomies,Large Bowel Resections,Resection, Large Bowel,Resections, Large Bowel
D003198 Computer Simulation Computer-based representation of physical systems and phenomena such as chemical processes. Computational Modeling,Computational Modelling,Computer Models,In silico Modeling,In silico Models,In silico Simulation,Models, Computer,Computerized Models,Computer Model,Computer Simulations,Computerized Model,In silico Model,Model, Computer,Model, Computerized,Model, In silico,Modeling, Computational,Modeling, In silico,Modelling, Computational,Simulation, Computer,Simulation, In silico,Simulations, Computer
D004210 Dissection The separation and isolation of tissues for surgical purposes, or for the analysis or study of their structures. Dissections
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013647 Task Performance and Analysis The detailed examination of observable activity or behavior associated with the execution or completion of a required function or unit of work. Critical Incident Technique,Critical Incident Technic,Task Performance,Task Performance, Analysis,Critical Incident Technics,Critical Incident Techniques,Incident Technic, Critical,Incident Technics, Critical,Incident Technique, Critical,Incident Techniques, Critical,Performance, Analysis Task,Performance, Task,Performances, Analysis Task,Performances, Task,Task Performances,Task Performances, Analysis,Technic, Critical Incident,Technics, Critical Incident,Technique, Critical Incident,Techniques, Critical Incident
D014584 User-Computer Interface The portion of an interactive computer program that issues messages to and receives commands from a user. Interface, User Computer,Virtual Systems,User Computer Interface,Interface, User-Computer,Interfaces, User Computer,Interfaces, User-Computer,System, Virtual,Systems, Virtual,User Computer Interfaces,User-Computer Interfaces,Virtual System
D015203 Reproducibility of Results The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results. Reliability and Validity,Reliability of Result,Reproducibility Of Result,Reproducibility of Finding,Validity of Result,Validity of Results,Face Validity,Reliability (Epidemiology),Reliability of Results,Reproducibility of Findings,Test-Retest Reliability,Validity (Epidemiology),Finding Reproducibilities,Finding Reproducibility,Of Result, Reproducibility,Of Results, Reproducibility,Reliabilities, Test-Retest,Reliability, Test-Retest,Result Reliabilities,Result Reliability,Result Validities,Result Validity,Result, Reproducibility Of,Results, Reproducibility Of,Test Retest Reliability,Validity and Reliability,Validity, Face

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