***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 : We evaluated the effectiveness of five training methods -four structured and one unstructured-for teaching intracorporeal knot tying . Methods : Forty-three graduate students without prior laparoscopic experience were r and omly assigned to one of five training groups , and their performance in 10 intracorporeal knot tying trials was evaluated , using time to complete a knot as the outcome measure . Results : The average knot tying times for the four structured groups were significantly faster than the unstructured group ( p < 0.0001 ) . AMONG THE FOUR STRUCTURED GROUPS , THE MINIMALLY INVASIVE SURGICAL TRAINER-VIRTUAL REALITY ( MIST-VR ) AND THE BOX TRAINER DRILLS SHOWED THE MOST RAPID IMPROVEMENTS . THE MIST-VR IMPROVED AVERAGE SUTURING TIME FROM TRIAL ONE TO TRIAL TWO ( P = 0.05 ) , THE BOX TRAINER DRILLS GROUP IMPROVED FROM TRIAL ONE TO TRIAL FOUR ( P = 0.01 ) , AND THE OTHER TWO GROUPS SHOWED SLOWER IMPROVEMENTS . STATISTICALLY SIGNIFICANT CORRELATIONS WERE OBSERVED BETWEEN SCORES ON MIST-VR TASKS AND AVERAGE KNOT TYING TIMES ( R > 0.7 , p < 0.05 ) . Conclusion : Structured training can be useful for the development of laparoscopic skills . MIST-VR is a valuable part of this training , particularly in the objective evaluation of performance Background Laparoscopic suturing is one of the most difficult tasks in endoscopic surgery , requiring extensive training . The aim of this study was to determine the transfer validity of knot-tying training on a virtual-reality ( VR ) simulator to a realistic laparoscopic environment . Methods Twenty surgical trainees underwent basic eye – h and coordination training on a VR simulator  ( SIMENDO , DelltaTech , Delft , the Netherl and s ) until predefined performance criteria were met . Then , they were r and omized into two groups . Group A ( the experimental group ) received additional training with the knot-tying module on the simulator , during which they had to tie a double laparoscopic knot ten times . Group B ( controls ) did not receive additional manual training . Within a week the participants tied a double knot in the abdominal cavity of an anaesthetized porcine model . Their performance was captured on digital video and coded . Objective analysis parameters were : time taken to tie the knot and number of predefined errors made . Subjective assessment s were also made by two laparoscopic surgeons using a global rating list with a five-point Likert scale . Results Trainees in group A ( n = 9 ) were significantly faster than the controls ( n = 10 ) , with a median of 262 versus 374 seconds ( p = 0.034 ) . Group A made a significantly lower number of errors than the controls ( median of 24 versus 36 errors , p = 0.030 ) . Subjective assessment s by the laparoscopic experts did not show any significant differences in economy of movement and erroneous behavior between the two groups . ConclusionS urgical trainees who received knot-tying training on the VR simulator were faster and made fewer errors than the controls . The VR module is a useful tool to train laparoscopic knot-tying . Opportunities arose to improve simulator-based instruction that might enhance future training Background : The study aim was to compare the effectiveness of virtual reality and computer-enhanced video-scopic training devices for training novice surgeons in complex laparoscopic skills . Methods : Third-year medical students received instruction on laparoscopic intracorporeal suturing and knot tying  and then underwent a pretraining assessment of the task using a live porcine model . Students were then r and omized to objectives -based training on either the virtual reality ( n=8 ) or computer-enhanced ( n=8 ) training devices for 4 weeks , after which the assessment was repeated . Results : Posttraining performance had improved compared with pretraining performance in both task completion rate ( 94 % versus 18 % ; P<0.001 * ) and time [ 181±58 ( SD ) versus 292±24 * ] . Performance of the 2 groups was comparable before and after training . Of the subjects , 88 % thought that haptic cues were important in simulators . Both groups agreed that their respective training systems were effective teaching tools , but computer-enhanced device trainees were more likely to rate their training as representative of reality ( P<0.01 ) . Conclusions : Training on virtual reality and computer-enhanced devices had equivalent effects on skills improvement in novices . Despite the perception that haptic feedback is important in laparoscopic simulation training , its absence in the virtual reality device did not impede acquisition of skill BACKGROUND We hypothesized that the Minimally Invasive Surgery Trainer ( MIST-VR ; VP Medical R , London , U.K. ) would be as effective as the Yale Laparoscopic Skills Course in improving laparoscopic intracorporeal suturing skills . MATERIAL S AND METHODS Each student made six attempts to tie a knot laparoscopically . Students were then r and omized to train on the MIST-VR for five sessions ( six skills/session ) or the Yale Skills  for five sessions ( three skills/session ) over 5 days . On completion of training , all students were evaluated by a test consisting of six attempts to tie a laparoscopic knot . RESULTS The percentage improvement in knot tying time did not differ significantly in the pelvic trainer group ( 30 + /- 21 % ) ( from 443 + /- 135 to 311 + /- 137 seconds ) and the MIST-VR group ( 39 + /- 21 % ) ( from 409 + /- 109 to 256 + /- 140 seconds ) ( P = 0.308 ) . CONCLUSIONS The MIST-VR is equivalent to the Yale Skills Course for training in the advanced laparoscopic skill of intracorporeal suturing INTRODUCTION Laparoscopic surgery has become the st and ard of care for many surgical diseases . Haptic ( tactile ) feedback ( HFB ) is considered an important component of laparoscopic surgery . Virtual reality simulation ( VRS ) is an alternative method to teach surgical skills to surgeons in training . Newer VRS trainers such as the Simbionix Lap Mentor II provide significantly improved tactile feedback . However , VRSs are expensive and adding HFB software adds an estimated cost of $ 30,000 to the commercial price . The HFB provided by the Lap Mentor II has not been vali date d by an independent party . We used the Simbionix Lap Mentor II in this study to demonstrate the effect of adding an HFB mechanism in the VRS trainer . MATERIAL S AND METHODS The study was approved by the University of Cincinnati Institutional Review Board . Twenty laparoscopically novice medical students were enrolled . Each student was asked to perform three different tasks on the Lap Mentor II and repeat each one five times . The chosen tasks dem and ed significant amount of traction and counter traction . The first task was to pull leaking tubes enough and clip them . The second task was stretching a jelly plate enough to see its attachments to the floor and cut these attachments . In the third task , the trainee had to separate the gallbladder from its bed on the liver . The students were r and omized into two groups to perform the tasks with and without HFB . We used accuracy , speed , and economy of movement as scales to compare the performance between the two groups . The participants also completed a simple question naire that highlighted age , sex , and experiences in videogame usage . RESULTS The two groups were comparable in age , sex , and videogame playing . No differences in the accuracy , the economy , and the speed of h and movement were noticed . In fact , adding HFB to the Lap Mentor II simulator did not contribute to any improvement in the performance of the trainees . Interestingly , we found that videogame expert players tend to have faster and more economic motion in their dominant h and s. However , the performance accuracy was not significantly affected . CONCLUSION The presence of HFB has less effect than it thought to be on the performance of the novice trainees . This may suggest that better HFB is still needed . However , there may be visual compensation for the lack of haptics . Playing videogames has a positive impact on economy , and the speed of the dominant had motion without affecting its accuracy . Further research is needed to clarify the value of haptics to the expert surgeon and compare it to the new trainees Abstract Background : The fulcrum effect of the body wall on instrument h and ling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons . This study evaluated three types of laparoscopic simulator training to assess their ability to promote the user 's adaptation to the fulcrum effect . Methods : Thirty-two participants with no previous experience in laparoscopic surgery were r and omly assigned to one of four groups representing different training conditions . One group was assigned to use a virtual reality simulator ( MIST VR ) ; two others were given a laparoscopic Z or U maze-tracking task . The control group received no training . Subjects were asked to perform a 2-min laparoscopic cutting task under normal laparoscopic imaging conditions first before and then after training . Results : In the test trial , subjects who trained on MIST VR made significantly more correct incisions ( p < 0.0001 ) and fewer incorrect incisions ( p < 0.0001 ) . Conclusion : Training on a virtual reality simulator such as MIST VR helps laparoscopic novices adapt to the fulcrum effect faster BACKGROUND Based on prior success of virtual-reality ( VR ) trainers in imparting surgical skills , a r and omized and controlled study was design ed to determine whether VR training improves angled-telescope operative performance . METHODS Third-year medical students received instruction on the use of an angled laparoscope and subsequently underwent performance assessment of angled telescope navigational tasks in an anesthetized porcine model . Subjects were then r and omized to objective -based training with an angled-telescope simulator ( EndoTower ; Verefi Technologies , Elizabethtown , PA ) versus no training , followed by re assessment of performance . RESULTS Initially , there were no significant differences between VR-trained ( n = 9 ) and control ( n = 10 ) groups . After training , object visualization , scope orientation , and horizon error scores were significantly better in VR-trained than control groups ; subject-matched improvement in orientation score was 50.9 % versus 10.8 % ( P < .05 ) . CONCLUSIONS VR training in angled laparoscope use improves operative performance of novices . These data support growing evidence that VR training is highly effective in improving surgical skills outside of the clinical setting Objective To assess the effect of virtual reality training on an actual laparoscopic operation . Design Prospect i ve r and omised controlled and blinded trial . Setting Seven gynaecological departments in the Zeel and region of Denmark . Participants 24 first and second year registrars specialising in gynaecology and obstetrics . Interventions Proficiency based virtual reality simulator training in laparoscopic salpingectomy and st and ard clinical education ( controls ) . Main outcome measure The main outcome measure was technical performance assessed by two independent observers blinded to trainee and training status using a previously vali date d general and task specific rating scale . The secondary outcome measure was operation time in minutes . Results The simulator trained group ( n=11 ) reached a median total score of 33 points ( interquartile range 32 - 36 points ) , equivalent to the experience gained after 20 - 50 laparoscopic procedures , whereas the control group ( n=10 ) reached a median total score of 23 ( 22 - 27 ) points , equivalent to the experience gained from fewer than five procedures ( P<0.001 ) . The median total operation time in the simulator trained group was 12 minutes ( interquartile range 10 - 14 minutes ) and in the control group was 24 ( 20 - 29 ) minutes ( P<0.001 ) . The observers ’ inter-rater agreement was 0.79 . Conclusion Skills in laparoscopic surgery can be increased in a clinical ly relevant manner using proficiency based virtual reality simulator training . The performance level of novices was increased to that of intermediately experienced laparoscopists and operation time was halved . Simulator training should be considered before trainees carry out laparoscopic procedures . Trial registration Clinical Trials.gov NCT00311792 Training on a video trainer or computer-based minimally invasive surgery trainer leads to improved benchtop laparoscopic skill . Recently , improved operative performance from practice on a video trainer was reported . The purpose of this study was three fold : ( a ) to compare psychomotor skill improvement after training on a virtual reality ( VR ) system with that after training on a video-trainer , ( VT ) ( b ) to evaluate whether skills learned on the one training system are transferable to the other , and ( c ) to evaluate whether VR or VT training improves operative performance . For the study , 50 junior surgery residents completed baseline skill testing on both the VR and VT systems . These subjects then were r and omized to either a VR or VT structured training group . After practice , the subjects were tested again on their VR and VT skills . To assess the effect of practice on operative performance , all second-year residents ( n = 19 ) were evaluated on their operative performance during a laparoscopic cholecystectomy before and after skill training . Data are expressed as percentage of improvement in mean score/time . Analysis was performed by Student 's paired t-test . The VR training group showed improvement of 54 % on the VR posttest , as compared with 
    Output:
    
RESULTS Operation time was reduced by 17 - 50 % by VR training , depending on simulator type and training principles .
Proficiency-based training appeared superior to training based on fixed time or fixed numbers of repetition .
Simulators offering training for complete operative procedures came out as more efficient than simulators offering only basic skills training .
Skills in laparoscopic surgery can be increased by proficiency-based procedural VR simulator training .
There is substantial evidence ( grade IA - IIB ) to support the use of VR simulators in laparoscopic training