Transferability of laparoscopic skills using the virtual reality simulator



Skill transfer represents an important issue in surgical education, and is not well understood. The aim of this randomized study is to assess the transferability of surgical skills between two laparoscopic abdominal procedures using the virtual reality simulator in surgical novices.


From September 2016 to July 2017, 44 surgical novices were randomized into two groups and underwent a proficiency-based basic training consisting of five selected simulated laparoscopic tasks. In group 1, participants performed an appendectomy training on the virtual reality simulator until they reached a defined proficiency. They moved on to the tutorial procedural tasks of laparoscopic cholecystectomy. Participants in group 2 started with the tutorial procedural tasks of laparoscopic cholecystectomy directly. Finishing the training, participants of both groups were required to perform a complete cholecystectomy on the simulator. Time, safety and economy parameters were analysed.


Significant differences in the demographic characteristics and previous computer games experience between the two groups were not noted. Both groups took similar time to complete the proficiency-based basic training. Participants in group 1 needed significantly less movements (388.6 ± 98.6 vs. 446.4 ± 81.6; P < 0.05) as well as shorter path length (810.2 ± 159.5 vs. 945.5 ± 187.8 cm; P < 0.05) to complete the cholecystectomy compared to group 2. Time and safety parameters did not differ significantly between both groups.


The data demonstrate a positive transfer of motor skills between laparoscopic appendectomy and cholecystectomy on the virtual reality simulator; however, the transfer of cognitive skills is limited. Separate training curricula seem to be necessary for each procedure for trainees to practise task-specific cognitive skills effectively. Mentoring could help trainees to get a deeper understanding of the procedures, thereby increasing the chance for the transfer of acquired skills.

This is a preview of subscription content, log in to check access.


  1. 1.

    Singley MK, Anderson JR (1989) The transfer of cognitive skill. Harvard University Press, Cambridge

    Google Scholar 

  2. 2.

    Woodworth RS, Thorndike EL (1901) The influence of improvement in one mental function upon the efficiency of other functions. Psychol Rev 8:247–261

    Article  Google Scholar 

  3. 3.

    Gick ML, Holyoak KJ (1980) Analogical problem solving. Cognit Psychol 12:306–355.

    Article  Google Scholar 

  4. 4.

    Schliemann AD, Nunes T (1990) A situated schema of proportionality. Br J Dev Psychol 8:259–268

    Article  Google Scholar 

  5. 5.

    Thorndike EL (1914) Educational psychology: briefer course. Columbia University Press, New York

    Google Scholar 

  6. 6.

    Baker J, Côté J (2006) Shifting training requirements during athlete development: deliberate practice, deliberate play and other sport involvement in the acquisition of sport expertise. Essent Process Attaining Peak Perform 1:92–109

    Google Scholar 

  7. 7.

    Lee TD (1988) Transfer-appropriate processing: a framework for conceptualizing practice effects in motor learning. Adv Psychol 50:201–215

    Article  Google Scholar 

  8. 8.

    Jensen K, Ringsted C, Hansen HJ, Petersen RH, Konge L (2014) Simulation-based training for thoracoscopic lobectomy: a randomized controlled trial: virtual-reality versus black-box simulation. Surg Endosc 28:1821–1829.

    Article  PubMed  Google Scholar 

  9. 9.

    Sabbagh R, Chatterjee S, Chawla A, Kapoor A, Matsumoto ED (2009) Task-specific bench model training versus basic laparoscopic skills training for laparoscopic radical prostatectomy: a randomized controlled study. Can Urol Assoc J 3:22–30

    Article  Google Scholar 

  10. 10.

    Magill RA (2011) Motor learning and control: concepts and applications. McGraw-Hill, New York

    Google Scholar 

  11. 11.

    Bjerrum F, Sorensen JL, Konge L, Rosthøj S, Lindschou J, Ottesen B, Strandbygaard J (2016) Randomized trial to examine procedure-to-procedure transfer in laparoscopic simulator training. Br J Surg 103:44–50.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12:1117–1120

    CAS  Article  Google Scholar 

  13. 13.

    Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K, SAGES FLS Committee (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135:21–27.

    Article  PubMed  Google Scholar 

  14. 14.

    Dawe SR, Pena GN, Windsor JA, Broeders J, a. JL, Cregan PC, Hewett PJ, Maddern GJ (2014) Systematic review of skills transfer after surgical simulation-based training. Br J Surg 101:1063–1076.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Seymour NE, Gallagher AG, Roman SA, O’Brien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:458–463. (discussion 463–464)

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Våpenstad C, Buzink SN (2013) Procedural virtual reality simulation in minimally invasive surgery. Surg Endosc 27:364–377.

    Article  PubMed  Google Scholar 

  17. 17.

    Chen Z, Klahr D (1999) All Other things being equal: acquisition and transfer of the control of variables strategy. Child Dev 70:1098–1120.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Lehman DR, Nisbett RE (1990) A longitudinal study of the effects of undergraduate training on reasoning. Dev Psychol 26:952

    Article  Google Scholar 

  19. 19.

    Wentink M, Stassen LPS, Alwayn I, Hosman RJaW, Stassen HG (2003) Rasmussen’s model of human behavior in laparoscopy training. Surg Endosc 17:1241–1246.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Yang C, Heinze J, Helmert J, Weitz J, Reissfelder C, Mees ST (2017) Impaired laparoscopic performance of novice surgeons due to phone call distraction: a single-centre, prospective study. Surg Endosc.

    Article  PubMed  Google Scholar 

  21. 21.

    Kowalewski K-F, Hendrie JD, Schmidt MW, Garrow CR, Bruckner T, Proctor T, Paul S, Adigüzel D, Bodenstedt S, Erben A, Kenngott H, Erben Y, Speidel S, Müller-Stich BP, Nickel F (2017) Development and validation of a sensor- and expert model-based training system for laparoscopic surgery: the iSurgeon. Surg Endosc 31:2155–2165.

    Article  PubMed  Google Scholar 

  22. 22.

    Sabbagh R, Chatterjee S, Chawla A, Hoogenes J, Kapoor A, Matsumoto ED (2012) Transfer of laparoscopic radical prostatectomy skills from bench model to animal model: a prospective, single-blind, randomized, controlled study. J Urol 187:1861–1866.

    Article  PubMed  Google Scholar 

  23. 23.

    Kolozsvari NO, Kaneva P, Brace C, Chartrand G, Vaillancourt M, Cao J, Banaszek D, Demyttenaere S, Vassiliou MC, Fried GM, Feldman LS (2011) Mastery versus the standard proficiency target for basic laparoscopic skill training: effect on skill transfer and retention. Surg Endosc 25:2063–2070.

    Article  PubMed  Google Scholar 

  24. 24.

    Barnett SM, Ceci SJ (2002) When and where do we apply what we learn?: a taxonomy for far transfer. Psychol Bull 128:612

    Article  Google Scholar 

  25. 25.

    Akhigbe T, Zolnourian A, Bulters D (2017) Mentoring models in neurosurgical training: review of literature. J Clin Neurosci.

    Article  PubMed  Google Scholar 

  26. 26.

    Entezami P, Franzblau LE, Chung KC (2012) Mentorship in surgical training: a systematic review. Hand (N Y) 7:30–36.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Cui Yang.

Ethics declarations


Cui Yang, Uljana Kalinitschenko, Juergen Weitz, Christoph Reissfelder, Jens R. Helmert and Soeren Torge Mees have no conflict of interest or financial ties to disclose.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yang, C., Kalinitschenko, U., Helmert, J.R. et al. Transferability of laparoscopic skills using the virtual reality simulator. Surg Endosc 32, 4132–4137 (2018).

Download citation


  • Skill transfer
  • Laparoscopic training
  • Virtual reality simulator
  • Mentoring