***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 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 Background Training of skills in simulators is preferred over learning on patients so as to avoid undue injury to patients and to allow more efficient use of re sources . Most simulators are costly and require a dedicated space . The aim of this study was to evaluate a simple desktop simulator , the Mirror Trainer . Methods Thirty medical students were r and omly assigned to three groups . One group was taught laparoscopic suturing in the Mirror Trainer , the second group used a pelvic training box , while the third group served as a control group and did not receive any training . All suture attempts during training were recorded on video . A blinded , independent investigator analyzed the videos . At the completion of training , the suturing skills of each participant were evaluated in an animal model . Results Training with the Mirror Trainer required less time than with the pelvic trainer ( p < 0.001 ) . Compared with the control group , the Mirror Trainer group and the pelvic trainer group were significantly faster at creating three knots in the pig ( p = 0.001 and p = 0.004 , respectively ) . Both training groups performed equally well on the animal model ( p = 0.99 ) . Conclusion The Mirror Trainer and the pelvic trainer are equally effective in teaching laparoscopic suturing skills but training with the Mirror Trainer requires less time , can be done on any desktop , and is less costly INTRODUCTION Modernisation of Medical Careers dictates a shortening of the training required to achieve consultant status . Precisely what type of work these consultants could be expected to accomplish , and be trained to do , is not clear . The objective of this study was to demonstrate a method of stratifying urological workload so as to determine what a urological trainee , undergoing shortened training  , might be expected to do as a consultant and to use this stratification to help manpower planning within the specialty . PATIENTS AND METHODS A cohort study of all urological activity undertaken over a 3-year period in a single teaching hospital in the UK was performed . All out-patient , in-patient or day-case activity within the urological department was analysed in the years 2000 - 2002 . Urological activity was stratified according to the absolute numbers of patients presenting for different types of out-patient consultation , the grade of complexity of any surgical intervention undertaken , and the theatre re source consumed by the study population . RESULTS Utilising prospect ively collected data , it was possible to aggregate information about the contributions generalist and sub-specialty activity made to the overall workload of a urological unit . Whilst the majority of out-patient activity , and almost 88 % of the surgical workload , could be accomplished by consultants undergoing shortened training , 11.9 % of specialised urological activity , consuming nearly 43 % of the available theatre re source , was outwith the remit of such a specialist . CONCLUSIONS Shortened training seems able to satisfy the service delivery needs of the majority of out-patient and day-case urological activity . It will not , however , fulfil the need for subspecialty-based training required to cope with the large minority of patients necessitating complex surgical intervention . Specialist training programmes , promoting advanced operative skills , need to be evolved in parallel to shortened training so as to ensure global urological service provision for the future Background Laparoscopic camera navigation ( LCN ) is vital for the successful performance of laparoscopic operations , yet little time is spent on training . This study aim ed to develop an inexpensive LCN simulator , to design a structured curriculum , and to determine the transferability of skills acquired . Methods In this study , 0 ° and 30 ° LCN simulators were developed for use on a videotrainer platform . Transferability was tested by enrolling 20 medical students in an institutional review board-approved , r and omized , controlled , blinded protocol . Subjects viewed a video tutorial and were pretested in LCN on a porcine Nissen model . Procedures were videotaped and the LCN performance was scored by a blinded rater according to the number of st and ardized verbal cues required and the percentage of time an optimal surgical view ( % OSV ) was obtained . Procedure time also was recorded . Subjects were stratified and r and omized . The trained group practice d on the LCN simulator until competency was demonstrated . The control group received no training . Both groups were posttested on the porcine Nissen model . Results The constructed simulators required 35 man hours for development , cost $ 25 per board for material s , and proved to be durable . The trained group demonstrated significant improvement in verbal cues ( p = 0.001 ) , % OSV ( p < 0.001 ) , and procedure time ( p = 0.001 ) , whereas the control group showed improvement only in verbal cues ( p < 0.02 ) . At posttesting , the training group demonstrated significantly better scores for verbal cues ( 2.1 vs 8.0 ; p = 0.02 ) and % OSV ( 64 % vs 45 % p = 0.01 ) than the control group . Conclusion These data suggest that the LCN simulator is cost effective and provides trainees with skills that translate to the operating room Objective : To assess the impact of warm-up on laparoscopic performance in the operating room ( OR ) . Background : Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR . The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP . Methods : Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR . Participants were r and omized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group . After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up . All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale ( from 7 to 35 ) . Results : There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up , median 28.5 ( range = 18.5–32.0 ) versus median 19.25 ( range = 15–31.5 ) , P = 0.042 . The results demonstrated excellent reliability of the assessment tool used ( Cronbach 's & agr ; = 0.92 ) . Conclusion : This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP . The suggested program is short , easy to perform , and therefore realistic to implement in the daily life in a busy surgical department . This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR re sources Background  Surgical skills training outside the operating room is beneficial . The best methods have yet to be identified . The authors aim ed to document the predictive validity of simulation training in three different studies . Methods Study 1 was a prospect i ve , r and omized , multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training . The Global Operative Assessment of Laparoscopic Skills ( GOALS ) was used to evaluate operative performance . Study 2 retrospectively review ed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum .  Operative time was the variable used to determine resident improvement . Study 3 was a prospect i ve , r and omized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator .  Operative performance was assessed using GOALS . Results All three studies failed to demonstrate predictive validity . With GOALS used as the assessment tool , no difference was found between trained and untrained residents in studies 1 and 3 . In study 2 , the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group . Conclusions No correlation was found between the three types of training outside the operating room , and no improved operative performance was observed . Possible explanations include too few subjects , training introduced too late in the learning curve , and training criteria that were too easy . Additionally , simulator training focuses on precision , which may actually increase task time . Awareness of these issues can improve the design of future studies STUDY OBJECTIVE To compare laparoscopic-assisted vaginal hysterectomy ( LAVH ) and total laparoscopic hysterectomy ( TLH ) for the treatment of endometrial cancer . DESIGN R and omized , controlled trial . DESIGN CLASSIFICATION R and omized controlled trial ( Canadian Task Force classification I ) . SETTING Two gynecologic oncologic units of university hospitals . PATIENTS Seventy-two women with endometrial cancer r and omized to undergo either LAVH or TLH .  INTERVENTIONS Total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy , bilateral salpingo-oophorectomy , peritoneal washing , and systematic pelvic lymphadenectomy . MEASUREMENTS AND MAIN RESULT 
    Output:
    
Virtual reality training appears to decrease the operating time and improve the operative performance of surgical trainees with limited laparoscopic experience when compared with no training or with box-trainer training .