ScopePro Trainer System for Laparoscopic Skill Assessment 🅴

Reviewed by Dr. Reza Lankarani, General SurgeonFounder | Surgical Pioneering Newsletter and Podcast Series Editorial Board Member | Genesis Journal of Surgery and MedicineSurgical Endoscopyhttps://doi.org/10.1007/s00464-025-12017-4Accepted: 13 July 2025SummaryThe "ScopePro Trainer" system is a newly developed, low-cost, portable laparoscopic box simulator designed for training and objective assessment of psychomotor laparoscopic skills. Utilizing computer vision and passive markers on instruments, ScopePro Trainer differentiates itself by its ability to track and analyze not only linear motion but also the crucial angular (rotational) motion of surgical instruments, which is often overlooked by traditional simulators. A validation study successfully demonstrated its capacity to differentiate between novice, intermediate, and expert surgeons across various laparoscopic tasks. This system offers a significant advancement in surgical training by providing objective, personalized feedback, potentially enhancing the transfer of skills to the operating room.Key Themes and Important Ideas/Facts1. The Growing Need for Advanced Laparoscopic Skill Training and Objective AssessmentMinimally Invasive Surgery (MIS) Benefits and Skill Demands: MIS offers "many well-proven benefits" and is increasingly adopted, but it "requires the surgeon to develop a range of skills," including "hand–eye coordination, depth perception, and psychomotor skills."Limitations of Traditional Simulators: While both virtual and physical simulators (box trainers) exist, virtual simulators are often high-cost and lack realistic haptics, while many box trainers provide less information, particularly regarding "angular motion, such as rotation around its axis."Importance of Rotational Motion: Laparoscopic surgery involves "four degrees of freedom," and "Rotational movements around the axis are essential." Current simulators often only analyze linear motion (3 DoF), leaving out the critical "4th DoF (rotation around the z-axis)."Gap in Objective Feedback: The lack of feedback on rotational movements "limits the ability to provide objective feedback on movement control in 3D space, which is crucial for improving laparoscopic psychomotor skills."2. Introduction and Features of the ScopePro Trainer SystemObjective: The study's objective is "to present the ScopePro Trainer system and evaluate construct validity."System Description: ScopePro is a "low-cost, portable laparoscopic box simulator equipped with an optical recording system utilizing passive markers to measure the rotation of the laparoscopic instrument tip along its traditional linear motion."Technology: It uses a 10 mm USB camera for visual feedback and a pair of webcams inside the trainer to register "position and rotation of instruments for each hand." Programming is done using Python, incorporating OpenCV for image processing and distortion correction.Rotation Measurement: A key innovation is the use of "passive marker[s]...shaped like a spiral" which leverage the "linearity principle of the spiral" to convert the "step of a spiral" into a rotation angle. This allows for recording "rotation around the instrument's axis."Cost-Effectiveness: The functional prototype had an approximate cost of "500 USD," highlighting its potential as a "low-cost option for institutions." Its portability also allows "individuals interested in practicing their skills at home" to benefit.3. Validation Study Design and MethodologyParticipants: The study involved 32 participants categorized into three groups:Novices (N): 20 medical students with "no prior experience in laparoscopic surgery."Intermediates (I): 8 pediatric surgery residents (PGY-2 to PGY-4) who had performed "fewer than 10 laparoscopic surgical procedures."Experts (E): 4 pediatric surgeons who had performed "more than 100 laparoscopic procedures."Tasks: Participants performed three FLS-based laparoscopic tasks:Peg Transfer: Bimanual manipulation, grasping, hand-eye coordination, spatial perception.Pattern Cutting: Cutting, grasping, precision, hand-eye coordination.Intracorporeal Knots: Needle manipulation, suture management, knot tying, bimanual dexterity. This was considered "the most difficult task in this study."Metrics: Six metrics were used for assessment, related to time, linear motion, and angular motion:Time (T)Path Length (PL)Clockwise Turns (Nclk)Counterclockwise Turns (Ncclk)Total Number of Turns (NT)Ratio (R): "The relationship between instrument rotation (NT) and total path length. (revolutions/meter)" – interpreted as economy of turns.Statistical Analysis: ANOVA and Student's t-test with Tukey's correction were used to identify significant differences between groups (p ≤ 0.05).4. Key Findings and OutcomesDifferentiation of Skill Levels: The ScopePro Trainer "successfully validated" its ability to "differentiate between partici