Achieving interface and environment fidelity in the Virtual Basic Laparoscopic Surgical Trainer

Abstract

Virtual reality trainers are educational tools with great potential for laparoscopic surgery. They can provide basic skills training in a controlled environment and free of risks for patients. They can also offer objective performance assessment without the need for proctors. However, designing effective user interfaces that allow the acquisition of the appropriate technical skills on these systems remains a challenge. This paper aims to examine a process for achieving interface and environment fidelity during the development of the Virtual Basic Laparoscopic Surgical Trainer (VBLaST). Two iterations of the design process were conducted and evaluated. For that purpose, a total of 42 subjects participated in two experimental studies in which two versions of the VBLaST were compared to the accepted standard in the surgical community for training and assessing basic laparoscopic skills in North America, the FLS box-trainer. Participants performed 10 trials of the peg transfer task on each trainer. The assessment of task performance was based on the validated FLS scoring method. Moreover, a subjective evaluation questionnaire was used to assess the fidelity aspects of the VBLaST relative to the FLS trainer. Finally, a focus group session with expert surgeons was conducted as a comparative situated evaluation after the first design iteration. This session aimed to assess the fidelity aspects of the early VBLaST prototype as compared to the FLS trainer. The results indicate that user performance on the earlier version of the VBLaST resulting from the first design iteration was significantly lower than the performance on the standard FLS box-trainer. The comparative situated evaluation with domain experts permitted us to identify some issues related to the visual, haptic and interface fidelity on this early prototype. Results of the second experiment indicate that the performance on the second generation VBLaST was significantly improved as compared to the first generation and not significantly different from that of the standard FLS box-trainer. Furthermore, the subjects rated the fidelity features of the modified VBLaST version higher than the early version. These findings demonstrate the value of the comparative situated evaluation sessions entailing hands on reflection by domain experts to achieve the environment and interface fidelity and training objectives when designing a virtual reality laparoscopic trainer. This suggests that this method could be used successfully in the future to enhance the value of VR systems as an alternative to physical trainers for laparoscopic surgery skills. Some recommendations on how to use this method to achieve the environment and interface fidelity of a VR laparoscopic surgical trainer are identified.

Interaction fidelity in virtual simulators

“…Bien qu'il soit intuitif de penser qu'une haute-fidélité des simulateurs soit nécessaire pour améliorer l'efficacité de la formation [6,7], d'autres chercheurs ont montré que les simulateurs basse-fidélité pourraient suffire pour une formation efficace et efficiente [9,13]. Cependant, il y a actuellement un manque de lignes directrices pour la définition des niveaux appropriés de fidélité d'interaction dans les simulateurs chirurgicaux virtuels [3].…”

Comparing touch-based and head-tracking navigation techniques in a virtual reality biopsy simulator

“…Moreover, there is a high cost associated with existing high-fidelity VR simulators. On the other hand, low fidelity trainers can be sufficient for efficient training (Kim et al, 2003;Chellali et al, 2016). Nevertheless, there is still a lack of guidelines for how to achieve the appropriate levels of fidelity for VR surgical simulators.…”

Effects of interface on procedural skill transfer in virtual training: Lifeboat launching operation study

“…Virtual training has the potential to achieve five benefits: an extremely reduced risk of accidents during training, a controllable scenario and environment, cost effectiveness, repeatability, and an immersive experience . Virtual training, in particular, has been used in the military, medicine, fire fighting, and various other fields because it amplifies those benefits when training a subject is dangerous or the training environment is risky. Training organizations in these industries have been using virtual training and are actively exploiting the evolving VR hardware and software technologies.…”

“…Three interfaces chosen for training were as follows: a conventional interface used in desktop environments (i.e., a monitor and keyboard/mouse [MON/KEY]), an immersive game environment (i.e., a head‐mounted display [HMD] and joypad [HMD/JOY]), and a gesture‐controlled environment (i.e., an HMD and wearable sensors [HMD/WEA]). Subjects were trained with one of these three interfaces and evaluated using the real lifeboat and appliance for technical skills and procedural knowledge to assess the training transfer . The display fidelity of the HMD was higher than the monitor .…”