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Virtual reality simulators provide a safe and efficient means of acquiring laparoscopic skills. We evaluated whether training on a virtual reality laparoscopic cholecystectomy simulator (Lap Mentor) improves the performance of a live, unrelated laparoscopic urological procedure.A total of 32 medical students with no previous laparoscopic experience were oriented to the Lap Mentor, and then performed virtual reality laparoscopic cholecystectomy which was assessed by 2 experienced laparoscopists using the previously validated Objective Structured Assessment of Technical Skills scoring. Subjects were randomized to group 1, in which participants completed 6, 30-minute virtual reality training sessions within 3 weeks, or group 2, in which participants received no training. All participants then performed live laparoscopic nephrectomy in a porcine model and performance was evaluated using Objective Structured Assessment of Technical Skills by 2 experts blinded to training status.Mean total pretraining laparoscopic cholecystectomy Objective Structured Assessment of Technical Skills scores were comparable between the groups (16.9 +/- 4.3 for group 1 vs 15.4 +/- 6.2 for group 2, p = 0.4). After training total Objective Structured Assessment of Technical Skills scores for live porcine laparoscopic nephrectomy were significantly higher in group 1 compared to group 2 (21.0 +/- 6.8 vs 15.7 +/- 6.6, respectively, p = 0.03). Likewise, individual subcategory Objective Structured Assessment of Technical Skills scores were higher in group 1 than in group 2, although significant differences were noted only in the categories of instrument handling and knowledge of the procedure.Surgical skills acquired as a result of training on a virtual reality laparoscopic simulator are not procedure specific but improve overall surgical skills, thereby translating into superior performance of an unrelated live laparoscopic urological procedure.

Optical spectroscopy has been evaluated as an innovative technique for the ex vivo study of renal and prostate tumors. In this pilot study we assessed the ability of optical reflectance spectroscopy to reliably differentiate tumor and normal tissue in renal specimens.From January to April 2007 we completed optical reflectance spectroscopy measurements at several standardized tumor and normal parenchymal locations immediately after kidney tumor removal. The slopes of the optical reflectance spectroscopy curves were compared, and the correlation between tumor and normal parenchyma reflectance was assessed.Reliable measurements were obtained from 13 radical and 8 partial nephrectomy specimens. Histology was malignant in 15 cases (clear cell in 14 and papillary in 1) and benign in 6 cases of oncocytoma. Overall we found a significant difference between the average optical reflectance spectroscopy slopes of tumor and normal parenchyma (p = 0.03). In individual radical nephrectomy specimens optical reflectance spectroscopy measurements at different locations in the tumor showed an excellent correlation (r = 0.968). Normal parenchymal measurements also correlated well (r = 0.88), although there was poor correlation between tumor and nontumor tissue in the specimen (r = 0.07). In the partial nephrectomy subset we also found a close correlation among measurements made on the normal parenchymal margin of the tumor (r = 0.94) except in 1 case of a positive margin (oncocytoma), in which the measurement from the positive margin site did not correlate with that of the adjacent parenchymal margin (r = 0.48).Optical reflectance spectroscopy can help distinguish tumor from normal renal tissue in specimens immediately removed at surgery. Optical reflectance spectroscopy may allow real-time assessment of positive margins during partial nephrectomy.