Virtual reality (VR) is an emerging-technology that can teach surgeons
new procedures and can determine their level of competence before the
y operate on patients. Also VR allows the trainee to return to the sam
e procedure or task several times later as a refresher course. Laparos
copic surgery is a new operative technique which requires the surgeon
to observe the operation on a video-monitor and requires the acquisiti
on of new skills. VR simulation could duplicate the operative field an
d thereby enhance training and reduce the need for expensive animal tr
aining models. Our preliminary experience has shown that we have the t
echnology to model tissues and laparoscopic instruments and to develop
in real time a VR learning environment for surgeons. Another basic ne
ed is to measure competence. Surgical training is an apprenticeship re
quiring close supervision and 5-7 years of training. Technical compete
nce is judged by the mentor and has always been subjective. If VR surg
ical simulators are to play an important role in the future, quantitat
ive measurement of competence would have to be a part of the system. B
ecause surgical competence is ''vague'' and is characterized by such t
erms as ''too long, too short'' or ''too close, too far,'' it is possi
ble that the principles of fuzzy logic could be used to measure compet
ence in a VR surgical simulator. Because a surgical procedure consists
of a series of tasks and each task is a series of steps, we will plan
to create two important tasks in a VR simulator and validate their, u
se. These tasks consist of laparoscopic knot tying and laparoscopic su
turing. Our hypothesis is that VR in combination with fuzzy logic can
educate surgeons and determine when they are competent to perform thes
e procedures on patients.