Journal of Surgical Simulation 2016; 3: 32 - 42

Published: 30 December 2016


Original article

Unsupervised use of laparoscopic box trainers in a cohort of UK core surgical trainees

Joanne E. Bennett, Jane V. Carter, Chris J. Foy, Caroline D. Rodd and Robert J. Longman
Corresponding author: Joanne E. Bennett, Department of Colorectal Surgery, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK. Email:


Background: Laparoscopic box trainers have been shown to improve acquisition of skills transferable to the operating theatre. However, despite calls for take-home box trainers to be made widely available, the effectiveness of unsupervised use is unknown. The aim of this study was to identify differences in task performance between surgical trainees allocated a take-home box trainer compared with controls.

Methods: Thirty trainees at the beginning of their core surgical training (CST) were randomly allocated to control or intervention groups. A transfer task and a shape-cutting task were assessed according to the previously validated MISTELS system. Data were collected at the start and end of year one. The difference between pre- and post-study performance of each task was calculated. A survey was also undertaken to evaluate the use of the box trainers.

Results: For the transfer task, the means of the differences between trainees’ pre- and post-study performance scores for the control and intervention groups were 60.9 and 106.1, respectively (P = 0.041). For the shape-cutting task, the means of the differences between trainees’ pre- and post-study performance scores for the control and intervention groups were 7.6 and 4.8, respectively (P = 0.912). Only 12% of survey respondents used the box trainer once a month or more, however 65% rated it as sometimes helpful or very helpful.

Conclusions: In this study, unsupervised use of the box trainer was associated with improvement in a simple transfer task, but incorporation into a supervised laparoscopic training curriculum may be required for more complex


laparoscopy; simulation; training; surgical skills; portable simulation; education