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The use of a box trainer for practice of surgical skills is supported by other studies. A systematic review looking at the effects of different models of simulator training has shown that video and haptic-enabled boxes could improve technical skills of surgeons and were more effective when practised with a patient [ 24 ]. Similarly, a systematic review looking at the accuracy of laparoscopic training on a virtual reality simulator showed that virtual reality laparoscopic simulators were superior to the traditional box trainers [ 25 ]. Virtual reality laparoscopic simulators are now widely used for laparoscopic training. However, the use of a box trainer as a training tool for practicing surgical skills is commonly used in gynaecology and should not be overlooked. This may have beneficial outcomes in terms of patient safety.
The use of a box trainer for practicing surgical skills requires an increased level of training and experience by the trainer. The box trainer should be clean and well maintained. The box trainer should also be well maintained in terms of the elasticity of the glove, the simulator joystick and the laparoscopic instruments. The trainer should not deteriorate over time and should have easy and clearly identified instructions for the trainee. The trainer should not be used for a prolonged period of time.
Further evaluation of the box trainer is required. This should include studies in terms of cost-effectiveness and comparison with other types of simulator training. It should also include studies assessing surgical complication rates in terms of minor and major adverse events.
The inclusion of a task trainer in the box is our current goal. We are currently looking at ways of implementing our prototype’s virtual reality with a real tissue model so that the surgeon can simulate open versus laparoscopic surgery by following a series of video clips of a laparoscopic procedure (Fig. 2 ). By following the video clips the surgeon would experience the laparoscopic procedure like a hands-on surgeon.
When considered from the perspective of education, we are not necessarily advocating using the trainer box as a solo intervention for surgical training. It may be used in conjunction with the traditional setting of an in-patient facility with surgical staff and patients to provide additional support and feedback.
Moving forward, we are looking at an internet enabled platform for trainers, providing real time feedback from the trainer boxes. This means that when a trainee performs a task on the trainer he or she can be informed if the task has been performed satisfactorily or not by the online teacher. The trainer’s online score will be tracked by the patient resulting in an improved surgical experience for both the patient and surgeon. The potential to provide patients with online status updates and feedback will also be of great benefit. This can be done at the time of discharge from hospital with patients being informed of their progress post-operative and the impact of the surgical intervention.
The online platform would be compatible with touch screen tablets such as iPads or tablet computers and synchronised to serve as a remote presence for trainers. It would provide an immersive system with performance tracking, recording the trainee’s activities in the operating theatre and providing real time feedback.
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