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June 5, 2026

Prospective Validation of a Structured Virtual Reality Simulation Curriculum for Laparoscopic Cholecystectomy Training in Novice Surgeons

Key Points

This study aims to validate a structured VR simulation curriculum for laparoscopic cholecystectomy training and compare it with standard practice.
Single-blinded prospective study with novice surgical trainees with less than 3 years of experience.
Participants were allocated to either a structured VR simulation curriculum or standard deliberate practice.
Performance was evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) and numerical rating scale (NRS).
The structured VRST group had a median GOALS score of 17.6 compared to 14.0 in the control group (p = 0.013).
All subdomains of GOALS showed significant improvement in the intervention group.
Subjective performance ratings also improved significantly with a median NRS of 6.7 versus 4.8 (p = 0.036).

Abstract

Abstract Background Virtual reality simulation training (VRST) improves basic laparoscopic skills; however, evidence supporting structured, procedure-specific VR curricula remains limited. In particular, the transfer of VRST to operative performance in laparoscopic cholecystectomy (Lap-C) among novice surgeons has not been consistently demonstrated. Aims This study aimed to prospectively validate a structured, proficiency-based VRST curriculum for Lap-C and to compare its effectiveness with standard deliberate practice on the same simulator. Methods In a single-blinded prospective study, novice surgical trainees (3 years of clinical experience) attending a basic laparoscopic training course were allocated either to a structured, procedure-specific VRST curriculum or to standard deliberate practice. Laparoscopic performance was assessed during a standardized porcine Lap-C. Blinded raters evaluated performance using the Global Operative Assessment of Laparoscopic Skills (GOALS) and a numerical rating scale (NRS). Inter-rater reliability was analyzed using intraclass correlation coefficients (ICC). Results Seventy-one participants were analyzed (intervention n = 19; control n = 52). The structured VRST group achieved significantly higher total GOALS scores compared with controls (median 17.6 vs. 14.0; p = 0.013). All GOALS subdomains—depth perception, bimanual dexterity, efficiency, tissue handling, and autonomy—were significantly improved in the intervention group. Subjective performance ratings were also higher following structured VRST (median NRS 6.7 vs. 4.8; p = 0.036). Inter-rater reliability for the total GOALS score was good (ICC = 0.80). Conclusion A structured, procedure-specific VR simulation curriculum significantly enhances laparoscopic cholecystectomy performance in novice surgeons compared to standard practice. These findings support the integration of structured VRST curricula into early surgical training to improve procedural proficiency and technical skill acquisition.Figure 1For image description, please refer to the figure legend and surrounding text. Figure 2For image description, please refer to the figure legend and surrounding text.

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