Contemporary virtual reality laparoscopy simulators: quicksand or solid grounds for assessing surgical trainees?

BACKGROUND: A demand for safe, efficient laparoscopic training tools has prompted the introduction of virtual reality (VR) laparoscopic simulators, which might be used for performance assessment. The purpose of this review is to determine the value of VR metrics in laparoscopic skills assessment. DATA SOURCES: An exhaustive search of the MEDLINE and EMBASE databases was performed to identify publications concerning construct, concurrent and predictive validation of VR simulators. Of 643 publications found, 42 were included in this review. Studies into all 3 types of validation showed a large heterogeneity in study design. Although concurrence of VR metrics with box trainer metrics, mental aptitude tests, and in vivo surgical performance was generally weak, several metrics demonstrated construct validity in selected simulators. CONCLUSIONS: Using the right simulator, tasks, and metrics, trainees' and experts' laparoscopic skills can reliably be compared. However, VR simulators cannot yet predict levels of real life surgical skills