The term virtual reality (VR) refers to a computer-generated representation of an environment allowing sensory interaction (sound, sight, and touch), thus giving the impression of true realism. Because of the nature of laparoscopy, it will likely benefit from developments in VR technology.15 In fact, elaborating on the successful paradigm of flight-simulator training for pilots, the potential of VR applications for lapa-roscopic surgical skills training was proposed almost a decade ago. Recent advances in computer technology, combined with the consensus about the need for training surgeons outside the operating room but equally informative teaching settings, have led to the rapid development of laparoscopic VR simulators. Evidence has been accumulating that such simulators seem to be valid instruments in the acquisition of laparoscopic surgical skills. Moreover, a recent randomized trial has demonstrated that skills obtained through VR simulators can be transferred into the operating room.5
Ideal laparoscopic VR simulators must generate three-dimensional images on a two-dimensional monitor that appear to be "natural," allowing a high level of interactivity, stability, and reactivity to the surgeon's actions (Figure 12.3). Organs appearing on the monitor must be anatomically correct, with natural real-time deformation properties and resistance when manipulated, preserving natural traits such as bleeding or leakage when treated abusively.5 Haptic feedback is optional; however, it will be provided in all types of simulators in the near future. VR surgical simulators are still expensive, but can potentially be a beneficial adjunct to traditional laparoscopic training programs outside the operating room.
One additional but significant advantage of VR surgical simulators is the ability to evaluate trainee's psychomotor skill level objectively.15 Each trainee's psychomotor skill level can be easily scored and recorded. In case of MIST VR simulators, for example, each trainee's performance for both left and right hands, is objectively scored for time, error rate, and efficiency of movement for each task (Table 12.2). This use of VR
simulators as a metric has been considered to be important, providing trainees with a performance reference point.1 This may help in setting the benchmark of training, and also help in keeping trainees highly motivated throughout the training program.
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