Sample records for colpotomy
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Teoh, Deanna; Lowery, William J; Jiang, Xiaoyin; Ehrisman, Jessie; Halvorson, Paige; Broadwater, Gloria; Bentley, Rex; Secord, Angeles Alvarez; Sobolewski, Craig; Berchuck, Andrew; Havrilesky, Laura J; Valea, Fidel A; Lee, Paula S
2015-02-01
To evaluate if the use of Valleylab mode ("V mode") (Covidien, Mansfield, MA) electrothermal energy for colpotomy during total laparoscopic hysterectomy (LH) results in a smaller margin of thermal injury to the upper vagina compared with traditional cut/coagulate (cut/coag) electrothermal energy. Prospective randomized clinical trial (Canadian Task Force classification I). University medical center. A total of 101 subjects who underwent LH between June 2010 and August 2012. Subjects were randomized to colpotomy by V mode electrothermal energy or cut/coag electrothermal energy. The primary end point was the median depth of thermal injury measured in millimeters. The secondary end points included the proportion of subjects who developed granulation tissue, induration, infection, or dehiscence at the vaginal cuff at 4 weeks, 3 months, or 6 months postoperatively. There was no significant difference in the median depth of thermal injury in the cut/coag and V mode arms (anterior margin: 0.68 mm vs 0.63 mm [p = .94], posterior margin: 0.66 mm vs 0.70 mm [p = .87], respectively). Twenty-seven percent of subjects in each arm developed at least 1 of the clinical end points at 4 weeks, 3 months, or 6 months postoperatively (granulation tissue: 6%-18% vs 8%-21%, induration: 0%-2% vs 4%-5%, infection: 0%-4% vs 0%-10%, dehiscence: 2% vs 0% in the cut/coag and V mode arms, respectively), with no difference between arms (p = 1.0). The V mode does not reduce the depth of thermal injury compared with cut/coag electrothermal energy when used for colpotomy incision during total laparoscopic hysterectomy (Clinical Trials.gov ID: NCT02080546). Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.
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Choi, Chahien; Do, In-Gu; Song, Taejong
2018-04-09
The purpose of this study was to compare the degree of surgical smoke or vapor and lateral thermal damage caused by two different energy-based surgical devices (ESDs) used in colpotomy during total laparoscopic hysterectomy. Patients undergoing laparoscopic hysterectomy were randomly assigned to an ultrasonic ESD group (n = 20) or monopolar ESD group (n = 20). Colpotomy was performed using the assigned ESD. The degree of surgical smoke or vapor obstructing the laparoscopic view was assessed by two independent reviewers using a 5-point Likert scale, in which a higher score indicates worse visibility. The degree of the lateral thermal damage was measured as the width from the point of instrument application to the margins of the unchanged nearby tissue using a light microscope. The baseline characteristics did not statistically differ between the two groups. The degree of surgical smoke or vapor obstructing vision was 1.2 ± 0.8 points in the ultrasonic group and 3.9 ± 0.7 points in the monopolar groups (p < 0.001). The lateral thermal damage was significantly increased in the monopolar group compared to in the ultrasound group (1500 µm [1200-2500 µm] vs. 950 µm [650-1725 µm], p = 0.037). Ultrasonic ESD had better laparoscopic visibility and caused less lateral thermal damage during colpotomy compared to monopolar device.
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Wei, Dechao; Han, Yili; Li, Mingchuan; Wang, Yongxing; Chen, Yatong; Luo, Yong; Jiang, Yongguang
2016-06-11
Among the different organs used for NOTES (natural orifice translumenal endoscopic surgery) technique, the transvaginal approach may be the optimal choice because of a simple and secure closure of colpotomy site. Pure and hybrid NOTES transvaginal operations were routinely performed via transperitoneal access. In this study, we investigate the safety and feasibility of pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using conventional laparoscopic techniques in a porcine model. Six female pigs, weighing an average of 30 kg, were used in this study. Under general anesthesia, pure retroperitoneal NOTES transvaginal nephrectomy was conducted using standard laparoscopic instruments. Posterolateral colpotomy was performed, and the incision was enlarged laterally using blunt dissection and pneumatic dilation. A single-port device was inserted to construct the operative channel. The retroperitoneal space was created using sharp and blunt dissection under endoscopic guidance up to the level of the kidney. Dissection and removal of the kidney were performed according to standard surgical procedure, and the colpotomy site was closed using interrupted sutures. The survival and complications were observed 1 week postoperatively. Our results showed that two cases failed because of peritoneal rupture. One case was successful, but required the assistance of an extra 5 mm laparoscopic trocar inserted in the flank. Three cases of pure retroperitoneal NOTES transvaginal nephrectomy were completed, and survived 1 week after the operation. In these three cases, no intra- or postoperative complications were observed. All findings confirmed the safety and feasibility of the retroperitoneal pure retroperitoneal NOTES transvaginal nephrectomy using standard laparoscopic instruments, which suggested the possibility of clinical application in human beings in the future.
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Döderlein-Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy.
Stone, Daniel E; Malik, Shazia A; Doerhman, Pooja; Videla, Felipe L
2015-05-01
The aim of this study was to demonstrate the surgical steps of performing the Döderlein-Krönig hysterectomy. A video recording was made of the hysterectomy using an alternative technique described by Drs. Döderlein and Krönig in 1906. The patient in the video had stage 3 prolapse and desired surgical correction. The video demonstrates an exam under anesthesia, an anterior colpotomy, delivery of the uterine fundus through the colpotomy, and completion of the hysterectomy. The surgery was performed by a urogynecologist and a resident physician. The patient tolerated the procedure well and had no symptom recurrence at her 1-year follow-up visit. This video was presented at the 2014 International Urogynecological Association Annual Meeting in Washington, DC, as a nondiscussed video poster. This video can assist and educate others in using this technique for performing a hysterectomy. Possible benefits of this approach include decreased blood loss and improved visualization, especially in women with pelvic organ prolapse.
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An Ambulatory Surgery Service Feasibility Study at Madigan Army Medical Center, Tacoma, Washington
1978-08-01
sturmdorf) Benign Intraoral lesions Cervical cone Branchial arch appendages, Colpotomy, diagnostic excision Cryotherapy (alone)" Basla cell CA...petrous pyramid, atti- ceantrotomy, closure of fistula, exteneeration of air cells of petrous pyramid, mastoid antrotomy, removal of outer attic wall...here admission forms will be filled out. Patients will then take those forms to the Admissions Office and return to that clinic for stamin up of 1
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Pulvirenti, Elia; Toro, Adriana; Di Carlo, Isidoro
2010-01-01
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an innovative approach in which a flexible endoscope enters the abdominal cavity via the transesophageal, transgastric, transcolonic, transvaginal or transvescical route, combining the technique of minimally invasive surgery with flexible endoscopy. Several groups have described different modifications by using flexible endoscopes with different levels of laparoscopic assistance. Transvaginal cholecystectomy (TVC) consists in accessing the abdominal cavity through a posterior colpotomy and using the vaginal incision as a visual or operative port. An increasing interest has arisen around the TVC; nevertheless, the most common and highlighted concern is about the lack of specific instruments dedicated to the vaginal access route. TVC should be distinguished between "pure", in which the entire operation is performed through the transvaginal route, and "hybrid", in which the colpotomy represents only a support to introduce instruments and the operation is performed mainly by the classic transabdominal-introduced instruments. Although this new technique seems very appealing for patients, on the other hand it is very challenging for the surgeon because of the difficulties related to the mode of access, the limited technology currently available and the risk of complications related to the organ utilized for access. In this brief review all the most recent advancements in the field of TVC's techniques and instrumentations are listed and discussed.
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Urogenital surgery performed with the mare standing.
Seabaugh, Kathryn A; Schumacher, Jim
2014-04-01
Many urogenital procedures of the mare are commonly performed with the mare standing. Ovariectomy via colpotomy was described as early as 1903, and the Caslick vulvoplasty was first described in 1937. As knowledge expands and instruments become more specialized, techniques will improve. With the introduction of laparoscopy, clinicians have not only been able to improve the previously described urogenital procedures but also to devise new procedures. This article describes multiple surgeries of the female urogenital tract, all of which can be performed with the mare standing, and describes a variety of approaches to some portions of the female urogenital tract. Copyright © 2014 Elsevier Inc. All rights reserved.
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Yoong, Wai; Fadel, Michael G; Walker, Sophie; Williams, Sophie; Subba, Beena
2016-02-01
To compare surgical outcomes, cost-effectiveness, and patient satisfaction in women undergoing primary vaginal or laparoscopic ovarian cystectomy for benign ovarian cysts. Retrospective cohort control study (Canadian Task Force classification II-3). Gynecologic unit at a university-affiliated hospital. Fifty patients who underwent primary ovarian cystectomy either through the vaginal route via posterior colpotomy (n = 29) or laparoscopic route (n = 21). Nonmalignant ovarian cysts were initially determined by transvaginal ultrasonography and serum tumor markers. The index group of women (n = 29) underwent vaginal ovarian cystectomy via a posterior colpotomy incision, whereas the control group (n = 21) comprised women who had laparoscopic ovarian cystectomy using the traditional "grasp and peel" technique. The following outcomes were evaluated: duration of surgery, intraoperative complications, estimated blood loss, length of inpatient stay, and postoperative pain (visual analogue scale). The average cost of both surgical methods was calculated by factoring in theater time, equipment required, and the length of hospital stay. Patients were then surveyed to compare postoperative pain and satisfaction scores as well as the time taken to return to work (in days). The 2 groups had similar mean ages (35.79 vs 36.72 years) and cyst diameter (6.8 vs 6.6 cm) (p > .05 in both cases). Vaginal ovarian cystectomy took a mean of 13.7 minutes longer (91.7 vs 78.0 minutes, p < .001) to perform and resulted in a greater mean estimated blood loss (116.1 vs 95 mL, p < .001). The spillage rate in the index group was 6-fold less compared with control cases (6% ± 2.4% vs 35% ± 4.6, p < .01). Although patients from the index group spent a mean of 2 hours longer as inpatients (10.9 vs 8.9 hours, p < .001), they reported a lower mean visual analogue pain score (2.01/10 vs 3.95/10, p < .05) and higher patient satisfaction scores (8.2/10 vs 6.5/10, p < .001). Mean perioperative cost of women who underwent vaginal ovarian cystectomy was lower (£1690.13 vs 1761.67) and they returned to work quicker compared with the laparoscopic group (13.6 vs 39.2 days, p < .001). Vaginal ovarian cystectomies took longer to perform and led to longer inpatient stay. However, these women had less postoperative pain and reported higher satisfaction scores compared with laparoscopic ovarian cystectomy, with a quicker return to work. The vaginal approach is a viable and cost-effective alternative to the laparoscopic approach in carefully selected patients. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.
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Exploring the umbilical and vaginal port during minimally invasive surgery.
Tinelli, Andrea; Tsin, Daniel A; Forgione, Antonello; Zorron, Ricardo; Dapri, Giovanni; Malvasi, Antonio; Benhidjeb, Tahar; Sparic, Radmila; Nezhat, Farr
2017-09-01
This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.
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Niu, Jun; Song, Wei; Yan, Ming; Fan, Wei; Niu, Weibo; Liu, Enyu; Peng, Cheng; Lin, Pengfei; Li, Peng; Khan, Abdul Qadir
2011-04-01
Transvaginal cholecystectomy has been performed successfully at several research institutions worldwide using natural orifice transluminal endoscopic surgery (NOTES) techniques. However, it is a growing new surgical concept in China. Several technical challenges hinder the safe clinical application of NOTES. This study investigated transvaginal endoscopic cholecystectomy performed with the assistance of a single umbilical trocar and achieved helpful initial clinical experience. From May 2009 to April 2010, a total of 43 transvaginal human cholecystectomies were performed. A single umbilical trocar was used for safe access and laparoscopic assistance during the operation. After the gallbladder had been removed through the vagina, the colpotomy was closed with absorbable stitches under direct vision. In addition, Student's t-test was performed for two samples to estimate the superiority of NOTES over a conventional laparoscopic cholecystectomy (LC) operation. The procedure was successfully completed for all the patients. No intra- or post-operative complications occurred. The patients recovered promptly after surgery, and all were satisfied with ideal cosmetic outcomes. The postoperative pain, hospital stay, and cost of hospitalization with NOTES were much less than with conventional LC operations. Although endoscopic instruments specifically designed for NOTES are not available, the addition of an umbilical trocar is an optimal way to allow safe performance of NOTES procedures in an easily reproducible manner. The authors' initial experience demonstrates that this hybrid technique is potentially feasible and effective for reducing postoperative pain and recovery times while improving the cosmetic results of transvaginal cholecystectomy.
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Comparison of two methods of cervical cerclage by ultrasound cervical measurement.
Rozenberg, P; Sénat, M V; Gillet, A; Ville, Y
2003-05-01
To compare the effects of cerclage performed with a modified Shirodkar procedure or with McDonald's technique using transvaginal ultrasound measurement of the distance between the external os and the suture. We performed a retrospective study of all patients who underwent a prophylactic cerclage with either the modified Shirodkar procedure or the McDonald's technique over a 3-year period. Physicians chose the cerclage technique according to their own preferences. Transvaginal ultrasound examination of the cervix was performed 2 weeks after the cerclage to measure its functional length and the distance between the external os and the cerclage. During the study period, 14 patients had a cerclage with the modified Shirodkar procedure and 19 patients with the McDonald's technique. Twelve of these 33 patients (36.4%) delivered before 37 weeks. The obstetric characteristics of the patients in both groups were similar. There were no significant differences between the Shirodkar and McDonald groups as to the functional cervical length before (31.3 +/- 8.7 vs. 35.6 +/- 9.7 mm, respectively) or after (37.0 +/- 7.3 vs. 36.1 +/- 7.9 mm) cerclage, the distance between the external os and cerclage (16.7 +/- 3.8 vs. 14.0 +/- 5.2 mm), or the number of deliveries before 32 (0 vs. 2) and 34 (1 vs. 3) weeks. The anterior colpotomy of the Shirodkar procedure increased the distance between the external os and the cerclage by a mean of 2.7 mm. This slight gain does not justify exposing the patient to the risks related to this procedure. When cerclage is necessary, McDonald's technique seems preferable.
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One hundred cases of laparoscopic subtotal hysterectomy using the PK and Lap Loop systems.
Erian, John; El-Toukhy, Tarek; Chandakas, Stefanos; Theodoridis, Theo; Hill, Nicholas
2005-01-01
To evaluate the safety and short-term outcomes of laparoscopic subtotal hysterectomy using the PK and Lap Loop systems. Prospective observational study (Canadian Task Force classification II-2). Princess Royal University and Chelsfield Park Hospitals, Kent, UK. One hundred women who underwent laparoscopic subtotal hysterectomy for menorrhagia from February 2003 through July 2004. The procedure was performed using the Plasma Kinetic (PK) system to seal the vascular pedicles and the Lap Loop system to separate the uterus at the level of the internal os. The uterus was removed from the abdominal cavity mainly by morcellation or posterior colpotomy. Of 100 patients, 59 were operated on as outpatients. Mean patient age was 44.6 years, median parity was 2, mean body mass index was 26.8, and mean duration of symptoms was 4 years. Clinically, the uterus was enlarged in 70 patients, and preoperative ultrasound scanning suggested the presence of uterine myomas in 42 patients. In addition to hysterectomy, 47 patients had concomitant pelvic surgery. The mean total operating time was 45.5 minutes, and mean estimated blood loss was 114 mL. The overall major complication rate was 2%; two patients required blood transfusion after surgery. There were no bowel or urinary tract injuries, unintended laparotomy, return to operating room, or anesthetic complications. At follow-up, all patients were satisfied with surgery. Laparoscopic subtotal hysterectomy using the PK and Lap Loop systems for treatment of therapy-resistant menorrhagia is safe, can be performed as an outpatient procedure, and is associated with reduced operating time and high patient satisfaction.
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"Triangle of safety": anatomic considerations in transvaginal natural orifice surgery.
Roberts, Kurt; Solomon, Daniel; Bell, Robert; Duffy, Andrew
2013-08-01
The introduction of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) brings the loss of traditionally used cutaneous landmarks for safe peritoneal access. This video describes the use of landmarks within the posterior vaginal fornix to define a "triangle of safety" wherein the peritoneal cavity can be accessed while minimizing the risk of injury to surrounding structures. The triangle of safety is best identified in the following way. The cervix and posterior fornix are visualized. Then an imaginary clock located at the base of the cervix is envisioned. The superior two corners of the triangle are represented by the 4 and 8 o'clock positions on this imaginary clock. Sometimes the cervix needs to be grasped and elevated anteriorly so that the inferior apex of the triangle delineated by the center of the rectovaginal fold is better visualized. During hybrid TV NOTES, the rectovaginal pouch of Douglas is visualized from the umbilicus, and the vaginal port can then be safely passed through the center of the triangle. It is important that the vaginal port should be angled upward, aiming toward the umbilicus to avoid injury to the rectum. During pure TV NOTES, the incision is made with electrocautery from the 5 o'clock position to the 7 o'clock position within the triangle. The peritoneum is sharply entered, and the colpotomy is dilated with the surgeons' fingers. The triangle of safety defines a set of landmarks between the base of the cervix and the rectovaginal fold. It allows for a safe TV access for hybrid and pure TV NOTES while minimizing the risk of injury to surrounding structures.
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Minimal invasive laparoscopic hysterectomy with ultrasonic scalpel.
Gyr, T; Ghezzi, F; Arslanagic, S; Leidi, L; Pastorelli, G; Franchi, M
2001-06-01
The purpose of the study was to assess whether total laparoscopic hysterectomy with the ultrasonic scalpel offers advantages in term of intraoperative and postoperative outcomes over the conventional abdominal hysterectomy. A case-control study to compare patients undergoing total laparoscopic hysterectomy and women undergoing abdominal hysterectomy for benign conditions was designed. Matching criteria were the menopausal status, the need of adnexectomy, and the uterus weight. The laparoscopic procedure was carried out using an ultrasonically activated scalpel and the amputated uterus was removed transvaginally. Every part of the operation was carried out via laparoscopy, from the adnexal phase to the colpotomy. Abdominal hysterectomy was performed using a conventional laparotomic technique. Intraoperative and postoperative characteristics were analyzed. One hundred forty-four patients were enrolled, of whom 48 underwent total laparoscopic hysterectomy and 98 abdominal hysterectomy. No difference was found between groups in terms of operating time or intraoperative and postoperative infectious and noninfectious complications. The median (range) total consumption of morphine (0 mg [0 to 16] versus 15 mg [0 to 100], P <0.01) during the first 3 postoperative days was significantly lower in the laparoscopic group than in the laparotomic group. The median (range) time to regular diet (1[0 to 4] versus 2 [0 to 5], P <0.05) and the time to passage of stool (1[1 to 2] versus 2 [1 to 5], P <0.05) was shorter in the laparoscopic than in the laparotomic group. Total laparoscopic hysterectomy with the ultrasonic scalpel is feasible and safe, and offers not only cosmetic benefits but also reduces the need of analgesia and the time to return to a normal gastrointestinal function in comparison with the conventional abdominal hysterectomy.
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Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases.
Pugliese, Raffaele; Forgione, Antonello; Sansonna, Fabio; Ferrari, Giovanni Carlo; Di Lernia, Stefano; Magistro, Carmelo
2010-03-01
Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that aims at reducing or abolishing skin incisions and potentially also postoperative pain. The purpose of this study was to analyse operative and long-term results of a series of hybrid transvaginal cholecystectomy. Between July 2007 and May 2009, transvaginal NOTES cholecystectomy for symptomatic cholelithiasis was performed by a hybrid technique in 18 women (mean age 54 years), including four women with a body mass index >30 kg/m(2). Dissection was conducted in the first four cases by a round-tip unipolar electrode (UE) introduced through the operative channel of the endoscope coming from the vagina and in the last 14 cases by a ultrasonic scalpel (US) introduced through a 5-mm abdominal port. The short-term outcomes and the long-term results of the two methods were compared. The transvaginal approach entailed no intraoperative complication and no conversion. The overall mean duration of procedures was 75 min (range 40-190). In the first four cases (UE), the operating time was 148 min (range 140-190), whilst in the last 14 (US), it was considerably shorter, 53 min (range 40-60, p < 0.01). We experienced one biliary leak in the UE group, whilst morbidity with US was nil (p < 0.005). The biliary leak healed in 7 days with nasobiliary drainage. No other complications were encountered in either group. The mean follow-up was 12 months (range 1-22), and none of the patients has complained of dyspareunia or other colpotomy-related complications so far. Until specifically designed endoscopic tools are available for NOTES, the hybrid technique with US dissection conducted through a 5-mm port should be preferred in transvaginal cholecystectomy in order to shorten the duration of surgery and make this approach effective, safe and reproducible. After a mean follow-up of 1 year, none of our patients has complained of any problem related to transvaginal approach.
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Levinson, Kimberly L; Mahdi, Haider; Escobar, Pedro F
2013-01-01
The present study was performed to determine the optimal dosage of indocyanine green (ICG) to accurately differentiate the sentinel node from surrounding tissue and then to test this dosage using novel single-port robotic instrumentation. The study was performed in healthy female pigs. After induction of anesthesia, all pigs underwent exploratory laparotomy, dissection of the bladder, and colpotomy to reveal the cervical os. With use of a 21-gauge needle, 0.5 mL normal saline solution was injected at the 3- and 9-o'clock positions as control. Four concentrations of ICG were constituted for doses of 1000, 500, 250, and 175 μg per 0.5 mL. ICG was then injected at the 3- and 9-o'clock positions on the cervix. The SPY camera was used to track ICG into the sentinel nodes and to quantify the intensity of light emitted. SPY technology uses an intensity scale of 1 to 256; this scale was used to determine the difference in intensity between the sentinel node and surrounding tissues. The optimal dosage was tested using single-port robotic instrumentation with the same injection techniques. A sentinel node was identified at all doses except 175 μg, at which ICG stayed in the cervix and vasculature only. For both the 500- and 250-μg doses, the sentinel node was identified before reaching maximum intensity. At maximum intensity, the difference between the surrounding tissue and the node was 207 (251 vs 44) for the 500-μg dose and 159 (251 vs 92) for the 250-μg dose. Sentinel lymph node (SLN) biopsy was successfully performed using single-port robotic technology with both the 250- and 500-μg doses. For SLN detection, the dose of ICG is related to the ability to differentiate the sentinel node from the surrounding tissue. An ICG dose of 250 to 500 μg enables identification of a SLN with more distinction from the surrounding tissues, and this procedure is feasible using single-port robotics instrumentation. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.
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Crochet, Patrice; Aggarwal, Rajesh; Knight, Sophie; Berdah, Stéphane; Boubli, Léon; Agostini, Aubert
2017-06-01
Substantial evidence in the scientific literature supports the use of simulation for surgical education. However, curricula lack for complex laparoscopic procedures in gynecology. The objective was to evaluate the validity of a program that reproduces key specific components of a laparoscopic hysterectomy (LH) procedure until colpotomy on a virtual reality (VR) simulator and to develop an evidence-based and stepwise training curriculum. This prospective cohort study was conducted in a Marseille teaching hospital. Forty participants were enrolled and were divided into experienced (senior surgeons who had performed more than 100 LH; n = 8), intermediate (surgical trainees who had performed 2-10 LH; n = 8) and inexperienced (n = 24) groups. Baselines were assessed on a validated basic task. Participants were tested for the LH procedure on a high-fidelity VR simulator. Validity evidence was proposed as the ability to differentiate between the three levels of experience. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on experienced surgeons' performances. Outcome measures were simulator-derived metrics and Objective Structured Assessment of Technical Skills (OSATS) scores. Quantitative analysis found significant inter-group differences between experienced intermediate and inexperienced groups for time (1369, 2385 and 3370 s; p < 0.001), number of movements (2033, 3195 and 4056; p = 0.001), path length (3390, 4526 and 5749 cm; p = 0.002), idle time (357, 654 and 747 s; p = 0.001), respect for tissue (24, 40 and 84; p = 0.01) and number of bladder injuries (0.13, 0 and 4.27; p < 0.001). Learning curves plateaued at the 2nd to 6th repetition. Further qualitative analysis found significant inter-group OSATS score differences at first repetition (22, 15 and 8, respectively; p < 0.001) and second repetition (25.5, 19.5 and 14; p < 0.001). The VR program for LH accrued validity evidence and allowed the development of a training curriculum using a structured scientific methodology.