Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room

Abstract

PurposeTo evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance.MethodsIn a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.ResultsComparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.ConclusionsDespite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.

Virtual vitreoretinal surgery: validation of a training programme

“…In line with this argument, a previous study has shown that warm‐up training for vitreoretinal surgeons on the eyesi before doing real‐life vitreoretinal surgery is effective and gives a better final outcome in the operating room (Deuchler et al. ). In a busy clinical world, the eyesi Simulator is potentially a valuable tool for training and maintaining surgical skills, as it requires only minor supervision from experienced surgeons and enables to achieve better surgical skills.…”

EYESI surgical simulator: validity evidence of the vitreoretinal modules

“…Similarly, in vitreoretinal surgery, Deuchler et al. () showed a beneficial effect of warm‐up training on subsequent performance in the OR for both novice and experienced surgeons.…”

A surgical simulator for peeling the inner limiting membrane during wet conditions

“…We have shown that our eye surgery simulator has high validation for ILM peeling. However, it is necessary to introduce excellent skill evaluation and scoring methods such as those used in past studies using virtual reality [ 13 – 15 ]. Besides the video-based dynamic image analysis of the operator, installation of sensor functions in our simulator will allow us to propose a new design of surgical instruments and to construct a validation system.…”

“…This membrane is easy to obtain at low cost, but the reproducibility is low because of individual differences and because the film properties do not adequately mimic the natural ILM [ 12 ]. On the other hand, a virtual reality simulator such as the Eyesi (VRmagic, Mannheim, Germany) [ 13 ] has an ILM peeling task, and this simulator provides assessment and feedback of the task to the surgeon [ 13 – 15 ]. Although such devices are suitable for simulating surgery because of their high reproducibility and lack of ethical problems, obtaining three-dimensional data is often difficult, and extensive time is required to apply the new device to a computer.…”