***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 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 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 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 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 Background This study aim ed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills . Methods Two r and omized groups of students underwent a controlled training program . Both groups completed an identical test before and after training . The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect . To evaluate the subjective feeling of underst and ing and mastering , the students indicated this on a visual analog scale . Results Both groups showed a significant increase in the number of stitches placed during the posttest , and an increase in subjective feeling of underst and ing and mastering . The increase did not differ between the groups , indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique . Conclusions Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator 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 
    Output:
    
Training ( virtual reality ( VR ) or video trainer ( VT ) ) versus no training improves surgical skills in the majority of trials .
Both VR and VT are as effective in most studies .
VR training is superior to traditional laparoscopic training in the operating room .
Outcome results for VR robotic simulations versus robot training show no clear difference in effectiveness for either model .
Contrasting results are observed when robotic technology is compared with manual laparoscopy .
Conclusion : VR training and VT training are valid teaching models .
Practicing on these models similarly improves surgical skills .
VR training is superior to unstructured traditional training in the operating room .
The reciprocal effectiveness of the other models to learn surgical skills has not yet been established