The Role of Simulator Promis2 in Learning Laparoscopic Skill

Abstract

Introduction: Laparoscopic surgery is unique and complex in nature, so the training is necessary
before proceeding to operation room. Many computer aided simulators have been developed for
the purpose. Our objective is to assess the improvement of basic laparoscopic skills after training in
simulator.
Methods: The fi fth year medical students underwent training of three laparoscopic skills using
Promis2 simulator twice weekly for 4-6 weeks. The skills are laparoscopic orientation, target pointing
and objects transferring. Time, path length of instruments and economy of movements were recorded.
The comparisons were made for these parameters between session fi rst and the last using a Mann-
Whitney U test.
Results: Ten volunteers completed the exercises in less time (186.3±55.4 seconds) than the fi rst
exercise (215.7±57.4 seconds) (P=0.0027). Both the right and left hand instrument path lengths were
also improved from 4425.8±1284.3 mm in the fi rst exercise to 3925.3±1313.6 mm in the last exercise
in the left side (P=0.0219) and likewise from 4273.8±1859.4 mm to 3831.3±1717.4 mm in the right side
(P=0.0027). Economy of the movement in the left handed instrument improved from 1114.4±453.5
mm in the fi rst exercise to 966.8±411.1 mm in the last (P=0.0443) and in the right handed instrument
from 845±398.8 mm to 771.4±370.5 mm according to the software of Promis2 simulator (P >0.005).
Conclusions: Training in Promis2 simulator improves the basic laparoscopic skills. The candidates
become consistently faster with shorter path lengths and had smoother instruments movements.
They also became signifi cantly more consistent in their performance.
Key Words: laparoscopy, promis2, simulator, training