***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: Objectives : Inanimate and virtual reality box training help in developing basic laparoscopic skills . The lack of tactile feedback and lack of reality may be a detriment when training with virtual reality trainers . This study examined the hypothesis that there is no difference in laparoscopic skills acquisition when virtual reality trainers are partially substituted for inanimate box trainers . Methods : Medical students without laparoscopic experience were r and omized into either Group A or Group B. Group A performed tasks on the LTS 2000 ( an inanimate box trainer ) alone for 10 sessions . Group B performed tasks on the box trainer as well as on the MIST-VR ( a virtual reality trainer ) for 10 sessions . Scores for 5 inanimate box trainer exercises  ( time and errors ) for the first and tenth sessions were compared between both groups . Results : No statistical differences were seen in any exercises in the first session between Group A ( n=14 ) and Group B ( n=18 ) in either time or errors ( P = NS for all comparisons ) . Mean times decreased in both groups from the first session to the last session . At the last session , again both groups demonstrated no differences in any of the exercises ( P = NS for all comparisons ) . Conclusions : No difference was found in laparoscopic skills acquisition when incorporating virtual reality trainers into a curriculum based on inanimate box trainers . Ideally , laparoscopic training laboratories should include both virtual reality and inanimate trainers 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 Objective This study evaluated , in a large , heterogeneous population , the outcome of  open cholecystectomy  as it is currently practice d. Summary Background and Data Although cholecystectomy has been the gold st and ard of treatment for cholelithiasis for more than 100 years , it has recently been challenged by the introduction of several new modalities including laparoscopic cholecystectomy . Efforts to define the role of these alternative treatments have been hampered by the lack of contemporary data regarding open cholecystectomy . Methods A population -based study was performed examining all open cholecystectomies performed by surgeons in an eastern and western state during a recent 12-month period . Data compiled consisted of a computerized analysis of Uniformed Billing ( UB-82 ) discharge analysis information from all non-Veterans Administration ( VA ) , acute care hospitals in California ( Office of Statewide Planning and Development [ OSHPD ] ) and in Maryl and ( Health Services Cost Review Commission [ HSCRC ] ) between January 1 , 1989 , and December 31 , 1989 . This data base was supplemented with a 5 % r and om sample of Medicare UB-82 data from patients who were discharged between October 1,1988 , and September 30 , 1989 . Patients undergoing cholecystectomy  were identified based on diagnosis-related groups ( DRG-197 and DRG-198 ) , and then classified by Principal Diagnosis and divided into three clinical ly homogeneous subgroups : acute cholecystitis , chronic cholecystitis , and complicated cholecystitis . Results A total of 42,474 patients were analyzed , which represents approximately 8 % of all patients undergoing cholecystectomy in the United States in any recent 12-month period . The overall mortality rate was 0.17 % and the Incidence rate of bile duct injuries was approximately 0.2 % . The mortality rate was 0.03 % in patients younger than 65 years of age and 0.5 % in those older than 65 years of age . Mortality rate , length of hospital stay , and charges were all significantly correlated ( p < 0.001 ) with age , admission status ( elective , urgent , or emergent ) , and disease status . Conclusions These data indicate that open cholecystectomy currently is a very safe , effective treatment for cholelithiasis and is being performed with near zero mortality . The ultimate role of PURPOSE With the exp and ing role of laparoscopy in urologic practice , efficient and safe training has become paramount . Virtual reality simulation may potentially aid training , but it requires validation before it can be incorporated into training programs . The objective of this study was to assess whether training on a virtual reality ( VR ) laparoscopy simulator ( LAP Mentor ) can improve performance of virtual laparoscopic procedures . MATERIAL S AND METHODS After a basic introduction to the LAP Mentor , 32 inexperienced medical students performed a baseline VR cholecystectomy  that was observed and scored by two observers using the Objective Structured Assessment of Technical Skills ( OSATS ) . The students were then r and omized to two groups : Group 1 trained on the simulator without supervision during a total of six 30-minute sessions , and group 2 received no training . Students were then reevaluated on a second VR cholecystectomy by the same observers . RESULTS All 32 students completed the study . The two groups were comparable with regard to baseline OSATS scores ( group 1 , 16.6+/-4.3 v group 2 , 15.67+/-6.3 , P=0.2 ) . On the second evaluation , the trained students ( group 1 ) performed significantly better than the control group ( group 2 ) ( 27.9+/-7.2 v 17.6+/-6.2 , P<0.001 ) . Group 1 students outperformed group 2 students in each category of the OSATS . Moreover , trained students improved their scores by at least 20 % ( P<0.001 ) in each category , while the untrained students improved only in the " knowledge of procedure " category by 25 % ( P=0.03 ) . CONCLUSION Skills training on a LAP Mentor VR simulator improved VR surgical performance . Before incorporating this simulator into resident education , the LAP Mentor will have to undergo testing for predictive and construct validity BACKGROUND This study compares a laparoscopic skill training protocol without proficiency targets to the same protocol with explicit targets and notification of progress . METHODS Fourteen surgery interns were r and omized into 2 groups . The intervention group received task-specific proficiency criteria to guide practice . The control group did not . After training , participants were evaluated by blinded faculty during laparoscopic cholecystectomy . RESULTS The control group met significantly fewer of the 7 LapSim ( Surgical Science Sweden AB , Gotëborg ) targets ( mean = 1.14 ) than the intervention group ( mean = 7.00 ; P = .001 ) and significantly fewer of the 5 video trainer targets ( mean = .86 ) than the intervention group ( mean = 5.00 ; P = .001 ) . Ratings of depth perception , bimanual dexterity , efficiency , tissue h and ling , autonomy , and overall competence were higher for the intervention group . Effect sizes ranged from medium to large ( .394-.981 ) , indicating an impact of the proficiency-based training protocol . CONCLUSIONS Delineation of proficiency targets with reporting of progress improves interns ' practice results , and appears to have a positive effect on their early operating room ( OR ) performance of laparoscopic cholecystectomy Evaluation was performed on a prototype low-cost virtual-reality motor-skills simulator ( VRMSS ) created at the Telehealth Research Institute , John A. Burns School of Medicine , in conjunction with the National Biocomputation Center , Stanford University . The VRMSS is specifically design ed to teach baseline fine-motor skills used in surgery that are based on a matrix of elemental technical skills that comprise the tenets of surgical technique . Fifty-seven participants were r and omly assigned to one of three groups ( VRMSS , box trainer or no training ) . After training each group was evaluated using the LapSim from Surgical Sciences . The VRMSS and box trainer were similar in performance , but significantly better than the no training control group . The VRMSS has significant advantages over the box trainer , in that the VRMSS can provide scoring on several parameters of the task without the need of an instructor and the VRMSS is approximately 1/16(th ) the cost of the Lapsim 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 : This study was undertaken to investigate operating room performance of surgical residents , after participating in the Eindhoven virtual reality laparoscopic cholecystectomy training course . This course is the first formal surgical resident trainings course , using a variety of complementary virtual reality ( VR ) skills training simulation in order to prepare surgical residents for their first laparoscopic cholecystectomy . The course was granted EAES certification . Methods : The four-day course is based on multimedia and multimodality approach . A variety of increasingly difficult simulation training sessions , next to intimate focus-group “ knowledge sessions ” are included . Both basic and procedural VR simulation is featured , using MIST-VR and the Xitacts ' LapChol simulation software . The operating room performance of twelve surgical residents who participated in the course and twelve case-control counterparts were compared . The case-control grup was matched for clinical number laparoscopic cholecystectomy performance ( maximum of 4 procedures ) . Two observers analyzed a r and omly mixed videotape , featuring the part of the “ clip- and -cut ” procedure of the laparoscopic cholecystectomy , and were blinded for participants ' group status . Structured question naires including multiple observation scales were used to assess performance . Results : Residents of both the experimental and control group did not differ in demographic parameters , except for number of laparoscopic cholecystectomies in favor of the control group ( p-value 0.008 ) . Both observers judge the experimental group to perform significantly better ( p-value 0.004 and 0.013 ) . Experimental group residents valued their course highly in terms of their laparoscopic surgical skills improvement and the use of VR simulators in the surgical curiculum . Conclusions : The Eindhoven Virtual Reality laparoscopic cholecyctectomy training course improves surgical skill in the operating room above the level of residents trained by a variety of other training methods Background Not much is known about the exact role of force feedback in laparoscopy . This study aim ed to determine whether force feedback influences movements of instruments during training in laparoscopic tasks and whether force feedback is required for training in basic laparoscopic force application tasks . Methods A group of 19 gynecologic residents , r and omly divided into two groups , performed three laparoscopic tasks  in both the box trainer and the virtual reality ( VR ) trainer . The box-VR group began with the box trainer 
    Output:
    
Results : The results indicated any kind of simulator training ( black box , VR ) to be beneficial at novice level .
Optimal learning requires skills training to be conducted as part of a systematic training program .
Conclusions : Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training .