Box trainers

This chapter wiU discuss the development and role of different types of simulators in teaching MAS. We wiU discuss traditional box trainers, the use of virtual reality (VR), and efforts to standardize MAS training across the world. We will discuss the role of engineers in this process and how simulation may be used to enhance performance of both novices and experts through analysis of motion and force. Finally, we discuss how skills developed during simulation may be transferred to the operating room. 

A recent Cochrane Collaboration systematic review of the impact of laparoscopic box training on acquisition of laparoscopic skills found that in trainees with no previous laparoscopic experience, training on a laparoscopic box trainer improved time to task completion, decreased errors, and improved accuracy and overall performance when compared with trainees who received no simulation training [11]. 

Khan MW, Lin D, Marlow N, et al. Laparoscopic skills maintenance a randomized trial of virtual reality and box trainer simulators. J Surg Educ 2014 71(1) 79—84. 

Physical simulation models include synthetic models of anatomy called phantoms or task-specific models hke the well-known peg transfer wooden model. Physical simulators can be used as a benchtop model for open surgical procedures or used in conjunction with a box trainer (a set up that includes an endoscopic camera, trocar ports and laparoscopic instruments, and a video screen) to teach minimally invasive procedures. 

Important to note however, Tanoue et al. found that training on VR simulators and box trainers are complementary, and that a combination of them should be included in a training curriculum [22]. Youngblood et al. s study demonstrated that naive subjects trained on a virtual—reality part-task trainer performed better on live surgical tasks in a porcine model as compared with those trained with a traditional box trainer [23]. 

There are many caveats that must be taken into account when designing a curriculum and training schedule around the use of phantoms and box trainers. Expert feedback and guidance must be adequately provided and distributed learning sessions should be incorporated to optimize learning. 

Munz Y, et al. Laparoscopic virtual reality and box trainers is one superior to the other Surg Endosc 2004 18(3) 485-94. 

Tanoue K, et al. Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer a randomized controlled trial. Surg Endosc 2008 22(4) 985-90. 

Simulators are developed primarily for the procedure(s) they are designed to emulate. Surgical simulators can include animal models, cadavers, synthetic and tissue-based bench models, computer/web-based simulators, video box trainers, web-based interface simulators, VR (or computer driven) part-task trainers, VR simulators that can allow the user to mimic an entire surgical procedure (whole-task trainers), hybrid simulators... 

Figure 10.4 Video box trainer with synthetic torso and laparoscopic training...

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