Immersive virtual reality enables technical skill acquisition for scrub nurses in complex revision total knee arthroplasty

Abstract

Introduction Immersive Virtual Reality (iVR) is a novel technology which can enhance surgical training in a virtual environment without supervision. However, it is untested for the training to select, assemble and deliver instrumentation in orthopaedic surgery—typically performed by scrub nurses. This study investigates the impact of an iVR curriculum on this facet of the technically demanding revision total knee arthroplasty. Materials and methods Ten scrub nurses completed training in four iVR sessions over a 4-week period. Initially, nurses completed a baseline real-world assessment, performing their role with real equipment in a simulated operation assessment. Each subsequent iVR session involved a guided mode, where the software taught participants the procedural choreography and assembly of instrumentation in a simulated operating room. In the latter three sessions, nurses also undertook an assessment in iVR. Outcome measures were related to procedural sequence, duration of surgery and efficiency of movement. Transfer of skills from iVR to the real world was assessed in a post-training simulated operation assessment. A pre- and post-training questionnaire assessed the participants knowledge, confidence and anxiety. Results Operative time reduced by an average of 47% across the 3 unguided sessions (mean 55.5 ± 17.6 min to 29.3 ± 12.1 min, p > 0.001). Assistive prompts reduced by 75% (34.1 ± 16.8 to 8.6 ± 8.8, p < 0.001), dominant hand motion by 28% (881.3 ± 178.5 m to 643.3 ± 119.8 m, p < 0.001) and head motion by 36% (459.9 ± 99.7 m to 292.6 ± 85.3 m, p < 0.001). Real-world skill improved from 11% prior to iVR training to 84% correct post-training. Participants reported increased confidence and reduced anxiety in scrubbing for rTKA procedures (p < 0.001). Conclusions For scrub nurses, unfamiliarity with complex surgical procedures or equipment is common. Immersive VR training improved their understanding, technical skills and efficiency. These iVR-learnt skills transferred into the real world.

Systematic Bibliometric Analysis of Research Hotspots and Trends on the Application of Virtual Reality in Nursing

“…Since the behavior intention of interns must be understood in the development of VCS ( 36 ), various virtual clinical skill training systems have been continuously developed and improved. The virtual nursing system promoting humanistic care covers, but is not limited to, the following: nursing various organs in the human body, mental and psychological care ( 37 ), oral nursing ( 38 ) skills in knee arthroplasty ( 39 ), hysteroscopic surgery nursing ( 40 ), nasogastric tube placement ( 41 ), and surgical suture ( 42 ). The nurse training program also includes management ability is ( 43 ).…”

Integration of Square Fiducial Markers in Patient-Specific Instrumentation and Their Applicability in Knee Surgery

“…Some authors have used XR technologies for training in replacement surgery. Thus, Edwards et al [ 47 ] have shown that immersive VR training improves scrub nurses’ understanding, technical skills, and efficiency in complex revision knee arthroplasty surgery. Zaid et al [ 48 ] carried out a randomized controlled trial of trainees at a single, large academic centre performing a relatively complex and unfamiliar procedure (unicompartmental knee replacement); VR training demonstrated equivalent SawBone model surgical competence compared with the use of traditional technique guides, as measured by surgical time and the Objective Structured Assessment of Technical Skills scores.…”

360° 3D virtual reality operative video for the training of residents in neurosurgery

“…Similar to our results, 360° videos improved the self-confidence of residents in orthognathic surgery for performing Le Fort I osteotomy. 42,43 We decided to tailor the enhanced 360° videos specifically to the needs of beginners, and the study participants were consequently young residents. Interestingly, however, there was no significant correlation between the number of surgical procedures already performed independently by the trainees and their assessment of the quality and usefulness of the videos.…”

“…For instance, Edwards et al demonstrated the improved confidence, understanding, technical skills, and efficiency of OR nurses with 360 ° videos. 43 Taken together, VR videos are substantially more sustainable and their benefits outweigh the high production costs. Furthermore, according to Benet et al, 3D imaging in neurosurgical research and education can help reduce overall healthcare costs and improve patient outcomes as a result of improved surgical skills and shortened learning curves.…”