British Journal of Obstetrics & Gynecology

Aggarwal R, Tully A , Grantcharov T et al. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. British Journal Of Obstetrics and Gynaecology[2006] 113(12) 1382-1387.

The use of Simulators is a part and parcel of flight-deck training, re-training, regular testing and adaptation in commercial, space and military aviation. It was only a matter of time before it found a place in endoscopic surgery.

This descriptive study of a virtual reality[VR] ectopic module on a simulator in the laparoscopic management of a tubal pregnancy, is a welcome one.

Until now, many training centres in laparoscopy in the UK had to make do with very basic systems to practice transfer of beads, or cutting through fluid-filled gloves or balloons.

This paper was written by 7 authors based in Denmark and the UK, although the study was conducted in central London Teaching Hospitals.

The subjects were 23 (from an initial 30) gynaecological surgeons of varying laparoscopic skills[ novice, intermediate and experienced]. After basic familiarisation by way of instrument navigation, they performed 10 simulated salpingectomies over time, using a bipolar grasper, diathermy scissors and a virtual bag.

The simulator program scored and recorded indices that translated to dexterity, surgical precision and prompt achievement of haemostasis.

The total time, total blood loss and ‘total instrument path length’ gradually improved with increasing number of sessions on the simulator. Remarkably, the trend appeared quicker in ‘novices’.

While such ‘novices’ might have thought that this was easier than the Super Nintendo, the subjects observe that in real-life, things were not as easy.

The use of simulators as has been demonstrated, appears inevitable as a step in the development of surgical skills, and in credentialing accredited practitioners. It must be welcomed as an additional facet in our training.