Acomparativestudyofskillsinvirtuallaparoscopyandendoscopy S. Adamsen, 1 P. M. Funch-Jensen, 2 A. M. Drewes, 3 J. Rosenberg, 4 T. P. Grantcharov 5 1 Department of Surgical Gastroenterology, Copenhagen University Hospital Herlev, DK-2730 Herlev, Denmark 2 Department of Surgical Gastroenterology, Aarhus University Hospital, DK-8000 Aarhus, Denmark 3 Department of Medical Gastroenterology, Center for Visceral Biomechanics and Pain, Aalborg University Hospital, DK-9000 Aalborg, Denmark 4 Department of Surgical Gastroenterology, Copenhagen University Hospital Gentofte, DK-2900 Hellerup, Denmark 5 Department of Surgical Gastroenterlogy, Copenhagen University Hospital Glostrup, DK-2600 Glostrup, Denmark Received: 19 April 2004/Accepted: 16 July 2004/Online publication: 2 December 2004 Abstract Background: The present study was designed to inves- tigate whether there is a correlation between manual skills in laparoscopic procedures and manual skills in flexible endoscopy. Methods: In a prospective study using laparoscopy and endoscopy simulators (MIST-VR, and GI-Mentor II), 24 consecutive subjects (gastrointestinal surgeons, nov- ice and experienced gastroenterologists, and untrained subjects) were asked to perform laparoscopic and endoscopic tasks. Their performance was assessed by the simulators’ software and by observers blinded to the levels of subjects’ experience. Performance in experi- enced vs inexperienced subjects was compared. Score pairs of three parameters—time, errors, and economy of movement—were also compared. Results: Experienced subjects performed significantly better than inexperienced subjects on both tasks in terms of time, errors, and economy of movement (p < 0.05). All three performance parameters in laparoscopy and endoscopy correlated significantly (p < 0.02). Conclusion: Both simulators can distinguish between experienced and inexperienced subjects. Observed skills in simulated laparoscopy correlate with skills in simu- lated flexible endoscopy. This finding may have an im- pact on the design of training programs involving both procedures. Key words: Laparoscopy — Endoscopy — Skills — Surgical training — Simulation It is often assumed that a talented laparoscopist is also a skilled endoscopist and vice versa. In some countries, diagnostic or therapeutic endoscopy is done by surgeons with varying degrees of formalized endoscopic training, whereas in other countries gastroenterologists perform diagnostic laparoscopy and have wide experience in laparoscopic cholecystectomy [14]. There are no objective data to show whether the mastery of flexible endoscopy implies that an individual has similar skills in the performance of laparoscopic procedures. Such correlated skills cannot be taken for granted, because flexible endoscopy and laparoscopy differ in several aspects, such as how the instruments are handled with one or both hands simultaneously, their different characteristics of flexible or stiff instruments, and whether the patient is awake, consciously sedated, or under general anesthesia. To design sensible, rational, and effective training programs, more evidence is needed on the nature of the psychomotor skills required for the performance of these principally different procedures. We therefore hypothesized that there is a correlation between clinical and virtual ability and that endoscopic ability predicts laparoscopic skills. The aim of the present study was to investigate whether skills in virtual laparoscopy predict performance in virtual flexible gastrointestinal endos- copy and vice versa. Methods Subjects Twenty-four gastrointestinal surgeons and gastroenterologists in dif- ferent stages of training were included. Their hand dominance, speci- alities, and endoscopic and laparoscopic experience were recorded on a form that was not seen by the observers. After the form was filled in, each subject performed a task on the laparoscopy simulator and immediately afterward an endoscopic task on the endoscopy simulator. Presented at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) meeting, Los Angeles, CA, USA, 14–15 March 2003, and as an oral oral presentation at the United European Gas- troenterology Week, Madrid, Spain, 1–5 November 2003 Correspondence to: S. Adamsen Surg Endosc (2005) 19: 229–234 DOI: 10.1007/s00464-004-9090-8 Ó Springer Science+Business Media, Inc. 2004