Does Box Model Training Improve Surgical Dexterity and Economy of Movement During Virtual Reality Laparoscopy? A Randomized Trial

Laparoscopy calls for particular skills that can be acquired and evaluated by various simulation methods. Numerous virtual reality (VR) models have been validated as training aids. There is evidence that trainees tend to prefer an inanimate box model trainer to a VR model if they must chose one of these. This randomized, controlled trial evaluated a low-cost box model trainer in 16 gynecological residents having limited experience with laparoscopy. All participants completed 7 basic training tasks on a VR laparoscopic trainer (LapSim). Half of the residents then trained for 3 hours using a structured box model training curriculum. Performance at baseline and after training was assessed using the LapSim, focusing on objective parameters such as time, error, and economy of motion. The residents undergoing box model training exhibited more improvement than did control residents in all parameters of performance: economy of movement, time, and tissue damage. It seems clear from these findings that using a box model trainer to learn laparoscopic skills does in fact improve basic skills as measured by a VR simulator. Improvement was most evident for economy-of-motion parameters, those that appear to be most valid for assessing technical laparoscopic skills. The investigators believe that box model trainers should be a part of comprehensive training curricula in gynecology. In addition, a low-cost box model trainer is an option for teaching hospitals lacking the economic resources needed to establish a VR system.