***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 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 AND STUDY AIMS The aim of this study was to evaluate four training programmes intended to help laparoscopic surgeons automate to the " fulcrum effect " . METHODS A total of 32 participants ( 16 men , 16 women ) , were r and omly assigned to one of four different image-viewing conditions : full binocular , y-axis inverted , normal laparoscopic and r and omly alternating ( between y-axis-inverted and normal laparoscopic ) . The subjects were requested to perform 10 trials of a simple laparoscopic cutting task , each lasting 2 minutes . Each then completed a 2-minute test under normal laparoscopic imaging conditions . RESULTS In the final test trial , participants who trained under the r and omly alternating imaging conditions ( y-axis inverted and normal laparoscopic ) performed significantly better than those from the other groups . CONCLUSION Training under a r and omly alternating viewing condition helps laparoscopic trainees automate to the " fulcrum effect " faster Abstract Background : Laparoscopic skill was measured objective ly through a series of seven tasks in an inanimate laparoscopic simulator . Seven analogous skills were tested in an in vivo porcine model . These skills included transferring , cutting , clipping , placement of a ligating loop , mesh placement , and suturing with an intracorporeal and extracorporeal knot . Scoring of each task rewarded precision and speed . Methods : Twelve PGY3 residents were given a baseline evaluation in the simulator and in the animal model . They were then r and omized to either five practice sessions in the simulator ( group A ) or no practice ( group B ) . Each group was retested in the simulator and in the animal ( final test ) . Scores in vivo were compared by t-test for baseline versus final evaluation for each group . Linear regression analysis was used to correlate in vivo and in vitro scores for each task and for the total score ( sum of all scores ) . Results : Group A showed significant improvement in performance in vivo for cutting , clipping , mesh placement , and suturing with an intracorporeal and extracorporeal knot , as well as in the total score ( p < 0.05 ) . Group B showed significant improvement in suturing with an intracorporeal and extracorporeal knot , and in the total score . The magnitude of improvement from baseline to final evaluation was significantly greater for group A ( p < 0.05 ) . There was significant correlation between in vitro and in vivo total scores and the score for each task ( p < 0.05 ) except for placement of the ligating loop and mesh . Conclusions : Performance in an in vitro laparoscopic simulator correlated significantly with performance in an in vivo animal model . Practice in the simulator result ed in improved performance in vivo 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 The " fulcrum effect " of the body wall on surgical instrument manipulation is a major hurdle for novice endoscopic surgeons .  Virtual reality training has not previously been evaluated as a means to overcome this problem . MATERIAL S AND METHODS 16 participants with no experience of endoscopy were required to make multiple defined incisions under laparoscopic laboratory conditions within 2-minute periods . Half of the subjects were r and omized to receive initial training on the Minimally Invasive Surgical Trainer , Virtual Reality ( MIST VR ) computer programme .  RESULTS Participants with MIST VR training made significantly more correct incisions ( P = 0.0001 ) than the control group on test trial 1 , and even after extended practice by both groups ( P = 0.0001 ) . They were also significantly more likely to actively use both h and s to perform the endoscopic evaluation task ( P = 0.01 ) . CONCLUSIONS Virtual reality training represents a potential , viable solution for junior endoscopists , for overcoming the " fulcrum effect " , in a replicable , safe learning environment which allows objective and reliable quantification of skill levels by trainers 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 55 % improvement by the VT group . The VR training group improved more on the VT posttest tasks ( 36 % ) than the VT training group improved on the VR posttest tasks ( 17 % ) ( p < 0.05 ) . Operative performance improved only in the VR training group ( p < 0.05 ) . Psychomotor skillsimprove after training on both VR and VT , and skills may be transferable . Furthermore , training on a minimally invasive surgery trainer , virtual reality system may improve operative performance during laparoscopic cholecystectomy 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 This study examined the impact of virtual reality ( VR ) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy Background : To vali date the usefulness of virtual reality surgical simulators , we investigated the transfer of skills achieved by their use to real tasks . Methods : Thirty medical students underwent a pretest using a real laparoscopic trainer . They were then r and omized to the following three groups : group I received no training ; group II received training using the Minimal Invasive Surgical Trainer in Virtual Reality ( MIST-VR ) ; and group III received training using conventional training exercises . Each group then underwent a posttest . Using the Imperial College Surgical Assessment Device ( ICSAD ) , scores were generated for time taken , distance traveled , number of movements made , and speed of instrument movement . Results : Significant changes between the MIST-VR group ( group II ) and the conventionally trained group ( group III ) , were observed in the speed of movement of the left h and and the numbers of movements taken by each h and , when compared to the untrained group ( group I ) . Conclusion : The training of novices using MIST-VR yields quantifiable changes in skill that are transferable to a simple real task and are similar to the results achieved with conventional training BACKGROUND Traditionally , the acquisition of surgical skill has occurred entirely in the operating room . To meet the exp and ing challenges of cost containment and patient safety , novel methods of surgical training utilizing ex-vivo workstations are being developed . The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents ' operative performance . METHODS Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal ( TEP ) hernia repairs .  Operative performance was evaluated using a vali date d global assessment tool . Each resident was then r and omized to a control group or a trained group . A CD ROM , video , and simulator were used for training . At the end of the study , each resident 's operative performance was again evaluated . RESULTS Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score ( P < 0.05 ) . Question naire data suggested that training result ed in improved underst and ing of the TEP hernia repair ( P =  
    Output:
    
Video simulation did not show consistently better results than groups with no training at all , and there were not enough data to determine if video simulation was better than st and ard training or the use of models .
Model simulation may have been better than st and ard training , and cadaver training may have been better than model training .
While there may be compelling reasons to reduce reliance on patients , cadavers , and animals for surgical training , none of the methods of simulated training has yet been shown to be better than other forms of surgical training