Limitations
STERILE
Due to the nature of the study and the spatial and temporal conditions, trainees from the iSurgeon and control group occasionally worked together in the same room. Thus, the flow of information between the two groups could have been a potential bias in both directions and within the two groups. Furthermore, since the training was conducted with students in different years of medical school (3rd to 6th year), a potential bias concerning the different levels of surgical education might have occurred. The inclusion criterium was the completion of the first module of the complementary MIS training curriculum, before which none of the participants had had any laparoscopic experience, but further previous surgical education was not assessed. However, besides the total time, the performance scores were comparable in the baseline LC. It is also important to mention that the intervention group had performed the baseline LC faster compared to the control group. This puts potential bias in the randomization process. However, the performance scores and all other compared parameters of the baseline LC were comparable between the two groups. Therefore, the study proceeded according to the predefined study protocol. One of the further limitations of the study is its small sample size, which could potentially influence the outcomes of the study.Finally, one must say that the environment in the training center where the LCs on porcine livers have been performed is not entirely comparable to an OR with a sterile covered operating field and that sound levels and disruptive factors due to the operating team consisting of surgeons, anesthesiologist, and nursing staff are higher in a real-life scenario. Nevertheless, this is also a chance for implementing the iSurgeon in a real-life OR setting to allow guidance when verbal feedback is difficult. This might, therefore, result in even higher benefits from telestration with AR in real-life conditions.