Skip to main content
Log in

Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The pulsatile organ perfusion (POP) trainer provides training of minimally invasive surgery (MIS) with real instruments and cadaveric organs. It provides training of full procedures with simulation of bleeding. Although widely used, the face validity has not yet been evaluated. This study aimed to establish face validity of the POP trainer for laparoscopic cholecystectomy (LC) and its usefulness compared with other training modalities.

Materials and methods

During MIS courses, the participants (n = 52) used the POP trainer to perform LC. Face validity was assessed with questionnaires for realism and usefulness on a five-point Likert scale. Participants were divided into two groups: experts (n = 15) who had performed more than 50 laparoscopic procedures and novices (n = 37) with less than 50 procedures. Secondary aims included the ranking of training modalities, as well as exploration of their specific advantages and disadvantages.

Results

The POP trainer was found to be realistic (3.8 ± 0.9) and useful (4.6 ± 0.9). Differences between experts and novices were only found for “The training modality resembles reality” (3.1 ± 0.8 vs. 3.8 ± 0.7; p = 0.010), “The operation on the POP trainer is realistic” (3.4 ± 1.1 vs. 4.5 ± 0.8; p = 0.003), and “It would be desirable to have a POP trainer at my own hospital” (4.2 ± 1.1 vs. 4.8 ± 0.8; p = 0.040). In the ranking, the animal training (1.1 ± 0.3) placed first, the POP trainer (2.3 ± 0.9) second, and the VR trainer (2.8 ± 0.9) and box trainer (2.8 ± 1.1) third. The realistic simulation of animal training was named as an advantage most often, while the unrealistic simulation of the VR trainer was the most often named disadvantage.

Conclusions

The POP trainer was rated a highly realistic and useful training modality with face validity for LC. Differences between experts and novices existed concerning realism and desirability. Future studies should evaluate the POP trainer for more advanced surgical procedures. The POP trainer widens the spectrum of modalities for training of MIS in a safe environment outside the operating room.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Gallagher AG, McClure N, McGuigan J, Crothers I, Browning J (1999) Virtual reality training in laparoscopic surgery: a preliminary assessment of minimally invasive surgical trainer virtual reality (MIST VR). Endoscopy 31(4):310–313. doi:10.1055/s-1999-15

    Article  CAS  PubMed  Google Scholar 

  2. Madan AK, Frantzides CT, Shervin N, Tebbit CL (2003) Assessment of individual hand performance in box trainers compared to virtual reality trainers. Am Surg 69(12):1112–1114

    PubMed  Google Scholar 

  3. Sharma M, Horgan A (2012) Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg 36(8):1732–1737. doi:10.1007/s00268-012-1564-6

    Article  PubMed  Google Scholar 

  4. Wyles SM, Miskovic D, Ni Z, Acheson AG, Maxwell-Armstrong C, Longman R, Cecil T, Coleman MG, Horgan AF, Hanna GB (2011) Analysis of laboratory-based laparoscopic colorectal surgery workshops within the English National Training Programme. Surg Endosc 25(5):1559–1566. doi:10.1007/s00464-010-1434-y

    Article  PubMed  Google Scholar 

  5. Clerici T, Lange J, Zerz A, Beller S, Szinicz G, Losert UO, Siegl H, Fugger R (1995) Educational opportunities in minimally invasive surgery. Wien Klin Wochenschr 107(2):43–48

    CAS  PubMed  Google Scholar 

  6. Szinicz G, Beller S, Zerz A (1997) Role of the pulsatile organ perfusion surgical simulator in surgery education. Langenbecks Arch Chir Suppl Kongressbd 114:687–693

    CAS  PubMed  Google Scholar 

  7. Szinicz G, Beller S, Zerz A, Bodner W (1994) The Pulsatile Organ Perfusion—a chance to reduce animal experiments in minimally invasive surgery training. Altex 11(1):40–43

    PubMed  Google Scholar 

  8. Arikatla VS, Sankaranarayanan G, Ahn W, Chellali A, De S, Caroline GL, Hwabejire J, DeMoya M, Schwaitzberg S, Jones DB (2013) Face and construct validation of a virtual peg transfer simulator. Surg Endosc 27(5):1721–1729. doi:10.1007/s00464-012-2664-y

    Article  PubMed  Google Scholar 

  9. Schijven M, Jakimowicz J (2002) Face-, expert, and referent validity of the Xitact LS500 laparoscopy simulator. Surg Endosc 16(12):1764–1770. doi:10.1007/s00464-001-9229-9

    Article  CAS  PubMed  Google Scholar 

  10. Nevo B (1985) Face validity revisited. J Educ Meas 22(4):287–293. doi:10.2307/1434704

    Article  Google Scholar 

  11. Cronbach LJ, Meehl PE (1955) Construct validity in psychological tests. Psychol Bull 52(4):281–302

    Article  CAS  PubMed  Google Scholar 

  12. Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240(3):518–525 (discussion 525–518)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nickel F, Hendrie JD, Stock C, Salama M, Preukschas AA, Senft JD, Kowalewski KF, Wagner M, Kenngott HG, Linke GR, Fischer L, Muller-Stich BP (2016) Direct observation versus endoscopic video recording-based rating with the objective structured assessment of technical skills for training of laparoscopic cholecystectomy. Eur Surg Res 57(1–2):1–9. doi:10.1159/000444449

    Article  PubMed  Google Scholar 

  14. Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ (2006) Characteristics of Medicaid and Uninsured Hospitalizations, 2012: Statistical Brief #182. In: Healthcare cost and utilization project (HCUP) statistical briefs. Agency for Health Care Policy and Research (US), Rockville (MD)

  15. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125

    CAS  PubMed  Google Scholar 

  16. Strasberg SM, Brunt LM (2010) Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg 211(1):132–138. doi:10.1016/j.jamcollsurg.2010.02.053

    Article  PubMed  Google Scholar 

  17. Nickel F, Jede F, Minassian A, Gondan M, Hendrie JD, Gehrig T, Linke GR, Kadmon M, Fischer L, Müller-Stich BP (2014) One or two trainees per workplace in a structured multimodality training curriculum for laparoscopic surgery? Study protocol for a randomized controlled trial—DRKS00004675. Trials 15:137. doi:10.1186/1745-6215-15-137

    Article  PubMed  PubMed Central  Google Scholar 

  18. Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC (2003) Cadaveric versus porcine models in urological laparoscopic training. Urol Int 71(3):310–315

    Article  PubMed  Google Scholar 

  19. Madan AK, Frantzides CT, Tebbit C, Quiros RM (2005) Participants’ opinions of laparoscopic training devices after a basic laparoscopic training course. Am J Surg 189(6):758–761. doi:10.1016/j.amjsurg.2005.03.022

    Article  PubMed  Google Scholar 

  20. Diesen DL, Erhunmwunsee L, Bennett KM, Ben-David K, Yurcisin B, Ceppa EP, Omotosho PA, Perez A, Pryor A (2011) Effectiveness of laparoscopic computer simulator versus usage of box trainer for endoscopic surgery training of novices. J Surg Educ 68(4):282–289. doi:10.1016/j.jsurg.2011.02.007

    Article  PubMed  Google Scholar 

  21. Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A (2004) Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc 18(3):485–494. doi:10.1007/s00464-003-9043-7

    Article  CAS  PubMed  Google Scholar 

  22. Scott DJ, Bergen PC, Rege RV, Laycock R, Tesfay ST, Valentine RJ, Euhus DM, Jeyarajah DR, Thompson WM, Jones DB (2000) Laparoscopic training on bench models: better and more cost effective than operating room experience? J Am Coll Surg 191(3):272–283

    Article  CAS  PubMed  Google Scholar 

  23. van Velthoven RF, Hoffmann P (2006) Methods for laparoscopic training using animal models. Curr Urol Rep 7(2):114–119

    Article  PubMed  Google Scholar 

  24. Roberts KE, Bell RL, Duffy AJ (2006) Evolution of surgical skills training. World J Gastroenterol 12(20):3219–3224

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hammoud MM, Nuthalapaty FS, Goepfert AR, Casey PM, Emmons S, Espey EL, Kaczmarczyk JM, Katz NT, Neutens JJ, Peskin EG (2008) To the point: medical education review of the role of simulators in surgical training. Am J Obstet Gynecol 199(4):338–343. doi:10.1016/j.ajog.2008.05.002

    Article  PubMed  Google Scholar 

  26. Undre S, Darzi A (2007) Laparoscopy simulators. J Endourol 21(3):274–279. doi:10.1089/end.2007.9980

    Article  PubMed  Google Scholar 

  27. Torkington J, Smith SG, Rees BI, Darzi A (2001) Skill transfer from virtual reality to a real laparoscopic task. Surg Endosc 15(10):1076–1079. doi:10.1007/s004640000233

    Article  CAS  PubMed  Google Scholar 

  28. Verdaasdonk EG, Stassen LP, Monteny LJ, Dankelman J (2006) Validation of a new basic virtual reality simulator for training of basic endoscopic skills: the SIMENDO. Surg Endosc 20(3):511–518. doi:10.1007/s00464-005-0230-6

    Article  CAS  PubMed  Google Scholar 

  29. Lee JY, Mucksavage P, Kerbl DC, Huynh VB, Etafy M, McDougall EM (2012) Validation study of a virtual reality robotic simulator—role as an assessment tool? J Urol 187(3):998–1002. doi:10.1016/j.juro.2011.10.160

    Article  PubMed  Google Scholar 

  30. Bullock G, Kovacs G, Macdonald K, Story BA (1999) Evaluating procedural skills competence: inter-rater reliability of expert and non-expert observers. Acad Med 74(1):76–78

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The current study was performed within the setting of the Collaborative Research Center 125: Cognition Guided Surgery, funded by the German Research Foundation (DFG).

Funding

The current study was supported by the Heidelberg Foundation for Surgery.

Authors’ contributions

Müller-Stich, Nickel, Rehberger, Fischer, Linke, and Bintintan were involved in study conception and design; Nickel, Hendrie, Rehberger, Kowalewski, Mayer, Kenngott, and Linke were involved in acquisition of data; Kowalewski and Nickel were involved in statistical analysis; Nickel, Hendrie, Rehberger, Mayer, Kowalewski, Bintintan, Kenngott, Linke, Fischer, and Müller-Stich were involved in analysis and interpretation of data; Nickel, Kowalewski, Hendrie, Kenngott, and Mayer drafted the manuscript; Müller-Stich, Fischer, Linke, and Bintintan were involved in critical revision.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Beat Peter Müller-Stich.

Ethics declarations

Disclosures

Felix Nickel reports receiving travel support for conference participation as well as equipment provided for laparoscopic surgery courses by KARL STORZ, Johnson & Johnson, and Medtronic. Vasile Bintintan reports receiving speaker fees by KARL STORZ, tutoring fees for courses by Covidien, as well as equipment for laparoscopic surgery courses by Ethicon. Karl-Friedrich Kowalewski, Florian Rehberger, Jonathan David Hendrie, Benjamin Friedrich Berthold Mayer, Hannes Götz Kenngott, Georg Richard Linke, Lars Fischer, and Beat Peter Müller-Stich have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nickel, F., Kowalewski, KF., Rehberger, F. et al. Face validity of the pulsatile organ perfusion trainer for laparoscopic cholecystectomy. Surg Endosc 31, 714–722 (2017). https://doi.org/10.1007/s00464-016-5025-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5025-4

Keywords

Navigation