***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Current assessment s using the fundamentals of laparoscopic surgery ( FLS ) tasks are labour intensive and depend heavily on expert raters . H and motion analysis may offer an alternative method of objective evaluation of FLS performance . Purpose The aim of this study was to assess whether a correlation exists between the expert rated assessment s of the FLS tasks and computer-based assessment of motion efficiency using the Imperial College surgical assessment device ( ICSAD ) . Methods We recruited 26 volunteer subjects who were stratified into three experience groups : juniors ( PGY1–3 ) ( N = 13 ) , seniors ( PGY4,5 ) ( N = 7 ) and staff surgeons ( N = 6 ) . All subjects performed four FLS tasks : ( 1 ) peg transfer , ( 2 ) pattern cut , ( 3 ) endoloop and ( 4 ) intracorporeal suturing . Performance was assessed by both st and ard FLS expert rating and motion analysis using ICSAD . Group differences were analyzed using the Kruskal – Wallis test , and Spearman coefficient analyses were employed to compare FLS and ICSAD scores . Results FLS expert-derived scores discriminated effectively between experience groups for all tasks ( p < 0.05 ) . Motion efficiency scores discriminated between experience groups for tasks 1 , 3 and 4 for number of movements ( p < 0.05 ) , tasks 1 and 4 for total distance ( p < 0.05 ) and tasks 1 , 2 , 3 and 4 for total time ( p < 0.005 ) . There was a significant correlation between total FLS expert scores and the motion efficiency metrics of total distance , number of movements and total time ( Spearman coefficient and p values of 0.81 , < 0.001 ; 0.76 ; < 0.001 ; and 0.93 , < 0.001 , respectively ) . Conclusion There is a high correlation between FLS st and ard scoring and motion efficiency metrics . The use of ICSAD for the objective assessment of FLS tasks may in the future offer an adjunctive method of evaluation . ICSAD metrics are potentially less labour intensive due to the instant and fully automated computerized scoring that it provides As video-game playing has become a ubiquitous activity in today 's society , it is worth considering its potential consequences on perceptual and motor skills . It is well known that exposing an organism to an altered visual environment often results in modification of the visual system of the organism . The field of perceptual learning provides many examples of training-induced increases in performance . But perceptual learning , when it occurs , tends to be specific to the trained task ; that is , generalization to new tasks is rarely found . Here we show , by contrast , that action-video-game playing is capable of altering a range of visual skills . Four experiments establish changes in different aspects of visual attention in habitual video-game players as compared with non-video-game players .  In a fifth experiment , non-players trained on an  action video game  show marked improvement from their pre-training abilities , thereby establishing the role of playing in this effect An important factor that may influence an individual 's performance is self‐efficacy , a personal judgement of capability to perform a particular task successfully . This prospect i ve study explored newly qualified surgeons ' and surgical trainees '  self‐efficacy in non‐technical skills compared with their non‐technical skills performance in simulated scenarios Background Video-games have become an integral part of the new multimedia culture . Several studies assessed video-gaming enhancement of spatial attention and eye-h and coordination . Considering the technical difficulty of laparoscopic procedures , legal issues and time limitations , the validation of appropriate training even outside of the operating rooms is ongoing . We investigated the influence of a four-week structured Nintendo ® Wii ™ training on laparoscopic skills by analyzing performance metrics with a vali date d simulator ( Lap Mentor ™ , Simbionix ™ ) . Methodology /Principal Findings We performed a prospect i ve r and omized study on 42 post-graduate I – II year residents in General , Vascular and Endoscopic Surgery . All participants were tested on a vali date d laparoscopic simulator and then r and omized to group 1 ( Controls , no training with the Nintendo ® Wii ™ ) , and group 2 ( training with the Nintendo ® Wii ™ ) with 21 subjects in each group , according to a computer-generated list . After four weeks , all residents underwent a testing session on the laparoscopic simulator of the same tasks as in the first session . All 42 subjects in both groups improved significantly from session 1 to session 2 . Compared to controls , the Wii group showed a significant improvement in performance ( p<0.05 ) for 13 of the 16 considered performance metrics . Conclusions / Significance The Nintendo ® Wii ™ might be helpful , inexpensive and entertaining part of the training of young laparoscopists , in addition to a st and ard surgical education based on simulators and the operating room OBJECTIVE To develop and establish effectiveness of simulation-based robotic curriculum -- fundamental skills of robotic surgery ( FSRS ) . METHODS FSRS curriculum was developed and incorporated into a virtual reality simulator , Robotic Surgical Simulator ( RoSS ) . Fifty-three participants were r and omized into an experimental group ( EG ) or control group ( CG ) . The EG was asked to complete the FSRS and 1 final test on the da Vinci Surgical System ( dVSS ) . The dVSS test consisted of 3 tasks : ball placement , suture pass , and fourth arm manipulation . The CG was directly tested on the dVSS then offered the chance to complete the FSRS and re-tested on the dVSS as a crossover ( CO ) group . RESULTS Sixty-five percent of participants had never formally trained using laparoscopic surgery . Ball placement : the EG demonstrated shorter time ( 142 vs 164 seconds , P = .134 ) and more precise ( 1.5 vs 2.5 drops , P = .014 ) . The CO took less time ( P < .001 ) with greater precision ( P < .001 ) . Instruments were rarely lost from the field . Suture pass : the EG demonstrated better camera utilization ( 4.3 vs 3.0 , P = .078 ) . Less instrument loss occurred ( 0.5 vs 1.1 , P = .026 ) . Proper camera usage significantly improved ( P = .009 ) . Fourth arm manipulation : the EG took less time ( 132 vs 157 seconds , P = .302 ) . Meanwhile , loss of instruments was less frequent ( 0.2 vs 0.8 , P = .076 ) . Precision in the CO improved significantly ( P = .042 ) and camera control and safe instrument manipulation showed improvement ( 1.5 vs 3.5 , 0.2 vs 0.9 , respectively ) . CONCLUSION FSRS curriculum is a valid , feasible , and structured curriculum that demonstrates its effectiveness by significant improvements in basic robotic surgery skills Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable Introduction FLS is an educational program developed by the Society of American Gastrointestinal and Endoscopic Surgeons and endorsed by the American College of Surgeons . The goal of the FLS program is to teach and assess the basic cognitive and psychomotor skills required to perform laparoscopic surgery . The purpose of this study is to review the results from the first 5 years of FLS certification testing . Methods FLS test data were prospect ively collected for all participants taking the FLS certification examination since its inception . Deidentified data were review ed and analyzed using st and ard descriptive statistics . Results The FLS examination was taken by 2,689 participants between October 2004 and December 2009 . There was a yearly increase in the number of individuals seeking FLS certification . Complete demographic information was available for 1,882 participants : 12 % were junior residents ( PGY 1–3 ) , 69 % were senior residents ( PGY 4–5 ) or fellows , and 19 % were attending surgeons . A breakdown of participants by specialty revealed that 88 % were general surgeons , 4 % were gynecologists , 2 % were urologists , and 6 % were labeled as “ other . ” The mean ( st and ard deviation , SD ) score on the cognitive examination was 519 ( 157 ) , with a 93 % pass rate . The mean score on the technical skills examination was 525 ( 117 ) , with a 92 % pass rate . After combining both scores , the overall FLS certification pass rate was 88 % . Conclusions The FLS certification examination has gained widespread acceptance among laparoscopic surgeons in training and practice , with a marked increase in testing since the American Board of Surgery m and ate for certification was announced . The overall pass rate of 88 % on the examination approaches the target pass rate of 90 % established during the test- setting process BACKGROUND Developing technical skill is essential to surgical training , but using the operating room for basic skill acquisition may be inefficient and expensive , especially for laparoscopic operations . This study determines if laparoscopic skills training using simulated tasks on a video-trainer improves the operative performance of surgery residents . STUDY DESIGN Second- and third-year residents ( n= 27 ) were prospect ively r and omized to receive  formal laparoscopic skills training  or to a control group . At baseline , residents had a vali date d global assessment of their ability to perform a laparoscopic cholecystectomy based on direct observation by three evaluators who were blinded to the residents ' r and omization status . Residents were also tested on five st and ardized video-trainer tasks . The training group practice d the video-trainer tasks as a group for 30 minutes daily for 10 days . The control group received no formal training . All residents repeated the video-trainer test and underwent a second global assessment by the same three blinded evaluators at the end of the 1-month rotation . Within-person improvement was determined ; improvement was adjusted for differences in baseline performance . RESULTS Five residents were unable to participate because of scheduling problems ; 9 residents in the training group and 13 residents in the control group completed the study . Baseline laparoscopic experience , video-trainer scores , and global assessment s were not significantly different between the two groups . The training group on average practice d the video-trainer tasks 138 times ( range 94 to 171 times ) ; the control group did not practice any task . The trained group achieved significantly greater adjusted improvement in video-trainer scores ( five of five tasks ) and global assessment s ( four of eight criteria ) over the course of the four-week curriculum , compared with controls . CONCLUSIONS Intense training improves video-eye-h and skills and translates into improved operative performance for junior surgery residents . Surgical curricula should contain laparoscopic skills training BACKGROUND The design of good virtual simulators for laparoscopic training requires realistic visual and tactile perception . This is a study to characterize the factors that contribute to forces during laparoscopic pinching . METHODS Surgeons were divided into four groups according to years of experience in laparoscopic surgery . They were asked to grasp six different types of porcine abdominal tissue  in a r and omly sequenced manner , using two different types of sensorized graspers , under two regimes of perceptual feedback ( with and without visual feedback ) . The forces ( grasper h and le force and grasper tip force ) and grasper h and le angle were recorded and analyzed . RESULTS The factors that determine forces during laparoscopic pinching can be ranked as follows : surgical experience ( p < .001 ) , tissue type ( p = .007 ) and visual feedback ( p = .033 ) , but not grasper type ( p = .071 ) . H and le force depends significantly on surgical experience ( p < .001 ) , tissue type ( p = .001 ) and visual feedback ( p = .019 ) , but not on grasper type ( p = 
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Data results showed that a myriad of cutting-edge technical innovations have provided modern surgical training tools such as the simulation-based mechanical and virtual reality simulators , animal and cadaveric labs , telementoring , telerobotic-assisted surgery , and video games .
Surgical simulators allow the trainees to acquire surgical skills in a tension-free environment without supervision or time constraints .