Training of laparoscopic skills with virtual reality simulator: a critical reappraisal of the learning curve

Background: The aim of this study was to determine the influence of different training levels with increasing complexity on the learning curve of a virtual reality (VR) laparoscopy simulator (LapSim(R)). Furthermore, this study was designed to identify reacquisition of performance in medical students. Methods: 14 medical students in their final year without previous laparoscopic experience were randomized into two groups, both of which performed the "clip application'' task. Group A (n = 7) had parameter adjusted to an easy level of performance, while group B (n = 7) was adjusted to a difficult level. Both groups were tested again at their respective level two months later. During both training sessions, each participant had to repeat the task ten times consecutively. Results: Both groups had improved parameter of performance when tested again after two months. Group A completed the second training session significantly faster than Group B and with less loss of blood. Parameter of performance plateaued in group A by the 6th repetition. However, such stable plateau was not reached in group B. Conclusions: This result suggests that steepness and plateau of a learning curve may be more dependent on the level of performance required by the particular training session rather than the number of repetitions during a session.