37 TRAINING IN VIRTUAL REALITY: CONSTRUCT VALIDITY OF A LAPAROSCOPIC NEPHRECTOMY SIMULATOR

Abstract

Introduction & Objectives: To optimize surgeon's pre-operative skills and to improve outcome in patients undergoing laparoscopic nephrectomy, several training models are being developed to teach surgical skills outside the operating theatre. The use and accuracy of training models should be assessed before implementing them in training programs. We aimed to assess construct validity of the Laparoscopic Nephrectomy (LN) Virtual Reality (VR) simulator, which is defined as the ability of the simulator to distinguish between different levels of experience. Material(s) and Method(s): A total of 63 participants were included: 22 novices (no laparoscopic experience), 32 intermediates (assisted or performed < 10 LN) and nine experienced urologists (performed> 10 LN). All participants performed three retroperitoneal test tasks on the LN VR simulator (Mentice, Sweden). These tasks consisted of dissecting the renal hilum and clipping and cutting the vessels. The simulator measured 62 parameters which we clustered and analysed in six categories: Time(sec), haemorrhage(ml), path length(m), errors(n), other(points) and total score (points). Result(s): In the first two tasks, intermediates performed better than novices for time (p=0.05), path length (p=0.02) other (p=0.01,p=0.05) and total score (p=0.01, p=0.02). Experienced participants completed the first two tasks faster than novices (p=0.05) but no differences in performance were found between experienced and intermediate participants. In the third task, no differences were found at all. Conclusion(s): A distinction between novices and intermediates can be made by the LN VR simulator on several parameters. However, these differences were not seen in task three. Poor discriminative ability was seen between intermediate and experienced participants. We therefore recommend further development of this promising simulator before implementing it in training programs. Furthermore, the interpretation of simulator parameters must remain subject of discussion.