Role of Virtual Reality Simulators in the certification of bariatric surgeons

AIMS: Several studies showed construct validity of virtual laparoscopic simulators for basic laparoscopic skills, however it is not yet clear whether the simulators can identify the actual experience of surgeons in more complex procedures such as laparoscopic Roux-en-Y gastric bypass. Our study tested the ability of the Lap Mentor simulator (SimbionixTM) to recognize the experience in advanced laparoscopic procedures assessing its role in the certification of bariatric surgeons. METHODS: 30 surgeons were divided into two groups according to their experience in laparoscopic and bariatric surgery: General group included 15 general surgeons performing between 75 and 100 non bariatric laparoscopic procedures; Bariatric group included 15 bariatric surgeons performing between 50 and 100 laparoscopic bariatric procedures. Participants were tested on the laparoscopic simulator in one basic task (Task 1: eye-hand coordination) and in two tasks of the gastric bypass module (Task 2: creation of the gastric pouch, Task 3: gastro-jejunal anastomosis). RESULTS: Comparing the groups, no significant differences were found in task 1 confirming the homogeneity of the two groups for basic laparoscopic skills. Analyzing the results from the gastric bypass module (bariatric vs. general), in task 2, significant differences (p < 0.05) were found in the median volume of the gastric pouch (22 vs. 48 cm3), in the percentage of fundus included in the pouch (8.8 vs. 30.1 %), in the complete dissection at the angle of His (14 vs. 4), and in safety parameters. In task 3, significant differences were found in the size and position of enterotomies. CONCLUSIONS: Lap MentorTM simulator is able to recognize specific skills of bariatric surgeons also in technical details that affect long-term results of the procedure such as dissection at the angle of His and gastric pouch volume. Furthermore, the possibility of analyzing in details the performance can help define skills where the surgeon is more lacking. These findings suggest a potential role in tailoring the training to maximize improvement. The Lap Mentor may be proposed as a certification tool for bariatric surgeons.