Evaluation of Laparoscopy Virtual Reality Training on the Improvement of Trainees’ Surgical Skills

Abstract

Background and objectives: The primary objective was to evaluate the benefit of training with virtual reality simulation. The secondary objective was to describe the short-term skill acquisition obtained by simulation training and to determine the factors affecting its magnitude. Materials and Methods: We prospectively performed a three-stage evaluation: face, constructive, and predictive to evaluate the training with a laparoscopic simulator with haptic feedback. The participants (n = 63) were divided according to their level of experience into three groups: 16% residents; 46% specialists and 38% were consultants. Results: Face evaluation demonstrates the acceptance of the design and realism of the tasks; it showed a median score of eight (IQR 3) on a Likert scale and 54% of participants (n = 34) gave the tissue feedback a moderate rating. Constructive evaluation demonstrates the improvement of the participants in the training session and the ability of the designed task to distinguish the experienced from the inexperienced surgeon based on the performance score, at task I (transfer of pegs) and II (laparoscopic salpingectomy). There was an improvement in both tasks with a significant increase in score and reduction in time. The study showed that those with a high score at the pre-test recorded a high score post-test, showing a significant pair-wise comparison (Z) and correlation (p) showing a significant statistical significance (p < 0.001). The predictive evaluation demonstrates the beneficiary effect of training four weeks afterward on the practice of surgeons addressed with five questions. It showed an improvement regarding implementation into daily routine, performance of procedure, suturing, shortening of the operative time, and complication management. Conclusions: Virtual reality simulation established high ratings for both realism and training capacity, including clinical relevance, critical relevance, and maintaining training enthusiasm.

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

“…Of the 46 empirical studies included in the second stage of the review, almost half (22/46, 48%) were quantitative descriptive studies [ 8 , 9 , 14 , 22 , 41 , 56 - 72 ], 11 (24%) were randomized controlled trials [ 6 , 7 , 17 , 20 , 23 , 73 - 78 ], 7 (15%) were quantitative nonrandomized studies [ 16 , 24 , 79 - 83 ], 5 (11%) were mixed methods studies [ 84 - 88 ], and 1 (2%) was a qualitative study [ 89 ]. They were published between 1999 [ 80 ] and 2021 [ 59 , 60 , 83 ]. Of the 46 studies, 21 (46%) were conducted in the United States [ 7 , 14 , 17 , 20 , 22 , 56 , 58 , 61 , 63 - 66 , 72 , 73 , 75 , 77 , 78 , 80 - 82 , 88 ], 4 (9%) in the United Kingdom [ 68 , 84 - 86 ], 3 (7%) each in China [ 24 , 67 , 70 ] and India [ 23 , 76 , 89 ], and 2 (4%) each in Germany [ 59 , 87 ], Taiwan [ 6 , 71 ], Italy [ 69 , 83 ], and France [ 57 , 79 ].…”

“…They were published between 1999 [ 80 ] and 2021 [ 59 , 60 , 83 ]. Of the 46 studies, 21 (46%) were conducted in the United States [ 7 , 14 , 17 , 20 , 22 , 56 , 58 , 61 , 63 - 66 , 72 , 73 , 75 , 77 , 78 , 80 - 82 , 88 ], 4 (9%) in the United Kingdom [ 68 , 84 - 86 ], 3 (7%) each in China [ 24 , 67 , 70 ] and India [ 23 , 76 , 89 ], and 2 (4%) each in Germany [ 59 , 87 ], Taiwan [ 6 , 71 ], Italy [ 69 , 83 ], and France [ 57 , 79 ]. Of the 46 studies, 2 (4%) did not provide a location [ 8 , 62 ] and 1 (2%) study was conducted in each of the following countries: Spain [ 16 ], Canada [ 74 ], Malaysia [ 60 ], the Netherlands [ 9 ], and Australia [ 41 ].…”

“…The interventions presented in the empirical literature aimed at improving technical, behavioral, or nontechnical skills. The technical skills included laparoscopic procedural skills and camera navigation [ 8 , 9 , 59 - 61 , 78 ], evacuation procedures [ 20 ], dental drilling techniques [ 70 ], and vesicourethral anastomosis during robot-assisted radical prostatectomy [ 24 ]. Nontechnical skills were less commonly focused on but included decision-making, communication, teamwork [ 56 , 85 ], and patient counseling and communication [ 89 ].…”

“…The first condition relates to when VR (all levels of immersion, with and without haptics), AR, and a combination of VR and AR training programs portray realistic (high-fidelity) simulations or imagery (eg, on patient anatomy). This triggered perceptions of reality, enabled visualization of patient anatomy, and triggered an interactive experience [ 9 , 22 , 56 , 59 , 61 , 63 - 65 , 67 - 70 , 72 , 79 , 80 , 82 - 87 ]. Easier visualization was explained through the use of 3D imagery, which often helped to reduce cognitive load and limit extraneous data [ 68 , 83 ].…”

“…Increased learner satisfaction was contested within the evidence. Some studies identified that their haptic tools hindered perceptions of realism [ 59 , 80 , 87 ]. Burdea et al [ 80 ] stated that the learners in their study were not satisfied with the VR simulator because it was not perceived as realistic.…”