Department of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
Maidstone Hospital, Hermitage Lane, Maidstone, ME16 9QQ, UK.
Ir J Med Sci. 2019 Aug;188(3):963-971. doi: 10.1007/s11845-018-1931-x. Epub 2018 Nov 19.
Virtual reality (VR) simulation is a vital component of surgical training with demonstrated improvements in surgical quality and clinical outcome.
To validate the LAP Mentor (Simbionix™) laparoscopic appendicectomy (LA) VR simulator with inclusion of a novel tool, Cognitive Task Analysis (CTA).
Thirty-two novices and nine experienced surgeons performed two simulated LAs. An expert-consensus questionnaire guided face validity assessment. Content validity was assessed using CTA-derived questions encompassing eight operative steps and four decision points. Construct validity was evaluated using dexterity metrics, masked assessment of surgical quality using the OSATS global rating scale, and mental workload from two validated tools: the NASA-TLX and SMEQ. Ten novices performed eight further LAs for learning curve assessment.
Face validity was demonstrated across all domains. Considering content validity, the essential technical and non-technical steps were evident. The experienced group performed the procedure quicker (median time 361 vs. 538 s, P = 0.0039) with fewer total movements (426 vs. 641, P < 0.0001) and shorter idle time (131 vs. 199 s, P = 0.0006). This correlated with higher OSATS scores (median 33.5 vs. 22.2, P < 0.0001) and lower mental demand (NASA-TLX: 9.0 vs. 13.75, P = 0.012; SMEQ: 60 vs. 80, P = 0.0025), indicating construct validity. Learning curve data showed statistically significant improvements after the 7th session for procedure time, total movements and idle time, which correlated with reduction in mental demand.
The LAP Mentor demonstrates face, content and construct validity for LA; thus, it can be used as an effective tool in surgical training. Task repetition leads to achievement of expert benchmarks.
虚拟现实 (VR) 模拟是手术培训的重要组成部分，已证明其可提高手术质量和临床效果。
验证 LAP Mentor（Simbionix™）腹腔镜阑尾切除术 (LA) VR 模拟器，其中包含一种新工具，认知任务分析 (CTA)。
32 名新手和 9 名经验丰富的外科医生进行了两次模拟 LA。采用专家共识问卷进行表面效度评估。内容效度使用 CTA 衍生问题进行评估，涵盖 8 个操作步骤和 4 个决策点。使用灵巧度指标评估构念效度，使用 OSATS 全球评分量表对手术质量进行掩蔽评估，使用两个经过验证的工具：NASA-TLX 和 SMEQ 评估心理工作量。10 名新手进行了另外 8 次 LA 以评估学习曲线。
所有领域均表现出表面效度。考虑到内容效度，明显存在必要的技术和非技术步骤。经验丰富的组完成手术更快（中位数时间 361 与 538s，P=0.0039），总运动次数更少（426 与 641，P<0.0001），空闲时间更短（131 与 199s，P=0.0006）。这与更高的 OSATS 评分（中位数 33.5 与 22.2，P<0.0001）和较低的心理需求（NASA-TLX：9.0 与 13.75，P=0.012；SMEQ：60 与 80，P=0.0025）相关，表明具有构念效度。学习曲线数据表明，在第 7 次手术后，手术时间、总运动次数和空闲时间均有统计学意义的改善，这与心理需求的降低相关。
LAP Mentor 对 LA 具有表面、内容和构念效度，因此可作为手术培训的有效工具。任务重复导致达到专家基准。
