Abstract

Introduction: Recent changes in post-graduate education, particularly in surgical training, have introduced novel devices using augmented reality (AR). This study aimed to validate the LapAR™ simulator, developed by Inovus Medical, guided by Messick’s validity framework. The primary objective was to assess its impact on improving skills of surgical trainees in laparoscopic appendectomies. 

Methods: 
A mixed-methods approach was used, combining a prospective cohort study and qualitative interviews. Fifteen trainees performed ten appendectomies at home using the LapAR™ simulator, interspersed with standardized procedural tasks. Performance was benchmarked against consultant surgeons. Primary outcome measures were procedure completion time and the distance traveled by instruments, with smoothness and acceleration of movements as secondary metrics. The study also explored qualitative feedback on the simulator’s usability, acceptability, and potential use cases. 

Results: 
Fifteen trainees and two consultant surgeons were recruited. Trainees achieved an average procedure completion time of 6.53 minutes, equivalent to consultants’ 6.76 minutes. The distance traveled by instruments decreased from 50.52 cm to 31.51 cm, also equivalent to consultant performance. Statistically significant improvements were noted in procedure time (p=0.001) and instrument distance travelled (p=0.043), though improvements in smoothness and acceleration did not reach significance. Qualitative analysis identified themes of enablers, barriers, and improved practice, highlighting flexibility and realism, with some setup issues reported. 

Conclusion: 
The LapAR™ simulator shows potential for enhancing laparoscopic skills and proving competency. It offers a new format for training and pre-operative warmups, though further research is needed to assess its construct and external validity and expand the cohort for generalisability.