Virtual reality training followed by box training improves the laparoscopic skills of novice surgeons

Background: The detailed influence of virtual reality training (VRT) and box training (BT) on laparoscopic performance is unknown; we aimed to determine the optimal order of imparting these training programs. Material and methods: This randomized controlled trial involved two groups, each with 20 participants without prior laparoscopic surgical experience: A BT-VRT group (60 min BT followed by 60 min VRT) and a VRT-BT group (60 mm VRT followed by 60 min BT). We objectively assessed the laparoscopic skills with a motion-analysis system (Hiroshima University Endoscopic Surgical Assessment Device: HUESAD), which reliably assesses surgical dexterity. Skill assessment was performed before and after the training session. Results: No inter-group differences were identified in the study measures at the pre-training assessment. In both groups, the performance on all tasks was significantly better at the post-training assessment than at the pre-training assessment. However, the outcome of the tests using the HUESAD was significantly better in the VRT-BT group than in the BT-VRT group at the post-training assessment. Conclusions: VRT followed by BT effectively improves the dexterity of novice surgeons during initial laparoscopic (combination) training.