Virtual reality simulator training for laparoscopic colectomy: What metrics have construct validity?

Skandan Shanmugan, Fabien Leblanc, Anthony J. Senagore, C. Neal Ellis, Sharon L. Stein, Sadaf Khan, Conor P. Delaney, Bradley J. Champagne

    Research output: Contribution to journalArticle

    20 Scopus citations

    Abstract

    Background: Virtual reality simulation for laparoscopic colectomy has been used for training of surgical residents and has been considered as a model for technical skills assessment of board-eligible colorectal surgeons. However, construct validity (the ability to distinguish between skill levels) must be confirmed before widespread implementation. Objective: This study was designed to specifically determine which metrics for laparoscopic sigmoid colectomy have evidence of construct validity. Design: General surgeons that had performed fewer than 30 laparoscopic colon resections and laparoscopic colorectal experts (>200 laparoscopic colon resections) performed laparoscopic sigmoid colectomy on the LA P Mentor model. All participants received a 15-minute instructional warm-up and had never used the simulator before the study. Performance was then compared between each group for 21 metrics (procedural, 14; intraoperative errors, 7) to determine specifically which measurements demonstrate construct validity. Performance was compared with the Mann-Whitney U-test (p < 0.05 was significant). Results: Fifty-three surgeons; 29 general surgeons, and 24 colorectal surgeons enrolled in the study. The virtual reality simulators for laparoscopic sigmoid colectomy demonstrated construct validity for 8 of 14 procedural metrics by distinguishing levels of surgical experience (p < 0.05). The most discriminatory procedural metrics (p < 0.01) favoring experts were reduced instrument path length, accuracy of the peritoneal/medial mobilization, and dissection of the inferior mesenteric artery. Intraoperative errors were not discriminatory for most metrics and favored general surgeons for colonic wall injury (general surgeons, 0.7; colorectal surgeons, 3.5; p = 0.045). Limitations: Individual variability within the general surgeon and colorectal surgeon groups was not accounted for. Conclusions: The virtual reality simulators for laparoscopic sigmoid colectomy demonstrated construct validity for 8 procedure-specific metrics. However, using virtual reality simulator metrics to detect intraoperative errors did not discriminate between groups. If the virtual reality simulator continues to be used for the technical assessment of trainees and board-eligible surgeons, the evaluation of performance should be limited to procedural metrics.

    Original languageEnglish (US)
    Pages (from-to)210-214
    Number of pages5
    JournalDiseases of the Colon and Rectum
    Volume57
    Issue number2
    DOIs
    StatePublished - Feb 1 2014

    Keywords

    • Construct validity
    • Education
    • Laparoscopic colectomy
    • Virtual reality simulation

    ASJC Scopus subject areas

    • Gastroenterology

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  • Cite this

    Shanmugan, S., Leblanc, F., Senagore, A. J., Ellis, C. N., Stein, S. L., Khan, S., Delaney, C. P., & Champagne, B. J. (2014). Virtual reality simulator training for laparoscopic colectomy: What metrics have construct validity? Diseases of the Colon and Rectum, 57(2), 210-214. https://doi.org/10.1097/DCR.0000000000000031