Abstract
Background
To determine realism and training capacity of HystSim, a new virtual-reality simulator for the training of hysteroscopic interventions.
Methods
Sixty-two gynaecological surgeons with various levels of expertise were interviewed at the 13th Practical Course in Gynaecologic Endoscopy in Davos, Switzerland. All participants received a 20-min hands-on training on the simulator and filled out a four-page questionnaire. Twenty-three questions with respect to the realism of the simulation and the training capacity were answered on a seven-point Likert scale along with 11 agree–disagree statements concerning the HystSim training in general.
Results
Twenty-six participants had performed more than 50 hysteroscopies (“experts”) and 36 equal to or fewer than 50 (“novices”). Four of 60 (6.6%) responding participants judged the overall impression as “7 – absolutely realistic”, 40 (66.6%) as “6 – realistic”, and 16 (26.6%) as “5 – somewhat realistic”. Novices (6.48; 95% confidence interval [CI] 6.28–6.7) rated the overall training capacity significantly higher than experts (6.08; 95% CI 5.85–6.3), however, high-grade acceptance was found in both groups. In response to the statements, 95.2% believe that HystSim allows procedural training of diagnostic and therapeutic hysteroscopy, and 85.5% suggest that HystSim training should be offered to all novices before performing surgery on real patients.
Conclusion
Face validity has been established for a new hysteroscopic surgery simulator. Potential trainees and trainers assess it to be a realistic and useful tool for the training of hysteroscopy. Further systematic validation studies are needed to clarify how this system can be optimally integrated into the gynaecological curriculum.






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References
Basdogan C, Sedef M, Harders M, Wesarg S (2007) Virtual reality supported simulators for training in minimally invasive surgery. IEEE Comput Graph Appl 27:54–66
Moorthy K, Munz Y, Sarker S, Darzi A (2003) Objective assessment of technical skills in surgery. BMJ 327:1032–1037
Schijven M, Jakimowicz J (2003) Virtual reality surgical laparoscopic simulators. Surg Endosc 17:1943–1950
Schijven MP, Jakimowicz JJ, Broeders IAMJ, Tseng LNL (2005) The Eindhoven laparoscopic cholecystectomy training course. Surg Endosc 19:1220–1226
Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB (2005) Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19:1523–1532
Aydeniz B, Meyer A, Posten J, König M, Wallwiener D, Kurek R (2000) The ‘HysteroTrainer’—an in vitro simulator for hysteroscopy and falloposcopy. Contrib Gynecol Obstet 20:171–181
Mandel LP, Lentz GM, Goff BA (2000) Teaching and evaluating surgical skills. Obstet Gynecol 95:783–785
VanBlaricom AL, Goff BA, Chinn M, Icasiano MM, Nielsen P, Mandel L (2005) A new curriculum for hysteroscopy training as demonstrated by an objective structured assessment of technical skills (OSATS). Am J Obstet Gynecol 193:1856–1865
Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A (2006) Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 113:1382–1387
Verdaasdonk EGG, Stassen LPS, Monteny LJ, Dankelman J (2006) Validation of a new basic virtual reality simulator for training of basic endoscopic skills: the SIMENDO. Surg Endosc 20:511–518
Schijven M, Jakimowicz J (2002) Face-, expert, and referent validity of the Xitact LS500 laparoscopy simulator. Surg Endosc 16:1764–1770
Ayodeji I, Schijven M, Jakimowicz J, Greve J (2007) Face validation of the Simbionix LAP Mentor virtual reality training module and its applicability in the surgical curriculum. Surg Endosc 21:1641–1649
Gallagher AG, Ritter EM, Satava RM (2003) Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17:1525–1529
Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463
Hart R, Doherty DA, Karthigasu K, Garry R (2006) The value of virtual reality-simulator training in the development of laparoscopic surgical skills. J Minim Invasive Gynecol 13:126–133
Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Jensen PF (2004) Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:146–150
Sedlack RE (2007) Validation of computer simulation training for esophagogastroduodenoscopy: Pilot study. J Gastroenterol Hepatol 22:1214–1219
Spaelter U, Moix T, Ilic D, Bleuler H, Bajka M (2004) A 4-dof haptic device for hysteroscopy simulation. Proc Int Conf Intell Robots Syst 4:3257–3263
Sierra R, Bajka M, Székely G (2006) Tumor growth models to generate pathologies for surgical training simulators. Med Image Anal 10:305–316
Sierra R, Zsemlye G, Székely G, Bajka M (2006) Generation of variable anatomical models for surgical training simulators. Med Image Anal 10:275–285
Gallagher AG, Ritter EM, Champion H, G.Higgins, Fried M, Moses G (2005) Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 241:364–372
Tuchschmid S, Bajka M, Bachofen D, Székely G, Harders M (2007) Objective surgical performance assessment for virtual hysteroscopy. Stud Health Technol Inform 125:473–478
Pearlman MD (2006) Patient safety in obstetrics and gynecology: an agenda for the future. Obstet Gynecol 108(5):1266–1271
Fenner DE (2005) Training of a gynecologic surgeon. Obstet Gynecol 105:193–196
Acknowledgments
The authors would like to thank all developers of the hysteroscopy simulator project. This research has been supported by the NCCR Co-Me (Computer Aided and Image Guided Medical Interventions) of the Swiss National Science Foundation (http://www.co-me.ch).
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Bajka, M., Tuchschmid, S., Streich, M. et al. Evaluation of a new virtual-reality training simulator for hysteroscopy. Surg Endosc 23, 2026–2033 (2009). https://doi.org/10.1007/s00464-008-9927-7
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DOI: https://doi.org/10.1007/s00464-008-9927-7