New perspectives in laparoscopic simulation:: From Students' Skills Lab to stress evaluation

Background: Application of a LapSim (R)-training model in the Students' Skills Lab as well as the objective evaluation of stress in a virtual operating room scenario offer new perspectives in laparoscopic simulation. Methods: In a Students' Skills Lab, assessment of learning curves of laparoscopic basic skills and complex tasks was carried out with 28 individuals at a LapSim (R) Virtual Reality (VR)-simulator in a training curriculum consisting of 9 units. In addition, in a virtual operating room scenario, stress evaluation was performed with 18 surgeons by means of a sympathicograph and, in that way, the laparoscopic error and complication rate were recorded. Three different stress reactions (SR 1-3) could be identified. Results: In the Students' Skills Lab, at the beginning of the curriculum (unit 1), the best learning effects together with the improvement of the laparoscopic performance could be presented for the two parameters: Extent of movement of the laparoscopic instruments (length of path as well as degree of deviation from the "optimal course") and duration of the procedure. In the virtual stress scenario, the intraoperative error rate of surgeons with a stress reaction without recovery (SR-1) was lower than of those with recovery (SR-2) or without stress reaction (SR-3). Conclusion: Application of the LapSim (R) Virtual Reality (VR)-simulator in the Students' Skills Lab and for stress and crisis simulation represents a new perspective in laparoscopic simulation, which will have to be further evaluated in the future. The transfer to the "real" operating room will have to be continued as a training and scientific validation paradigm.