Predictive Validation of a Robotic Virtual Reality Simulator: The Tube 3 module for Practicing Vesicourethral Anastomosis in Robot-Assisted Radical Prostatectomy

Shim, Ji Sung; Noh, Tae Il; Kim, Jae Yoon; Pyun, Jong Hyun; Cho, Seok; Oh, Mi Mi; Kang, Seok Ho; Cheon, Jun; Lee, Jeong Gu; Kim, Je Jong; Kang, Sung Gu

doi:10.1016/j.urology.2018.08.013

Cited by 14 publications

(12 citation statements)

References 19 publications

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“…The majority of VR studies in oncology were from North America continent ( n = 20, 37.8%) [ 4 , 6 , 8 , 10 – 12 , 16 , 17 , 25 , 28 , 33 , 34 , 37 , 50 , 51 , 53 – 56 ]. Asia ( n = 16, 30.2%) is the second most prolific continent [ 5 , 7 , 9 , 13 , 18 , 20 , 21 , 29 , 35 , 36 , 38 , 39 , 41 , 43 , 44 , 47 ], followed by Europe ( n = 11, 20.8%) [ 15 , 19, 22, 24, 31, 32, 45, 46, 48]. Fewer articles were published from centres based in Australia ( n = 3, 5.7%), [ 27 , 49 , 52 ] Africa ( n = 2, 3.8%), [ 23 , 26 ] and South America ( n = 2, 3.8%) [ 20 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of the 24 studies related to surgical oncology, 19 (79.2%) focused on the use of VR in supporting surgical trainees with competencies, [ 7 – 12 , 14 – 17 , 19 , 20 , 54 ] and the other five (20.8%) focused on pre-operative surgical planning [ 5 , 13 , 25 , 30 , 33 ]. VR was applied across different modalities of surgery, including open procedures ( n = 14, 58.3%), [ 5 , 8 , 11 – 14 , 16 , 17 , 26 , 28 – 30 , 33 , 54 ], minimally invasive ( n = 5, 20.8%) [ 7 , 9 , 10 , 19 , 22 ], and robotic ( n = 5, 20.8%) procedures [ 15 , 20 , 21 , 25 , 32 ]. Neurosurgical oncology procedures were the most studied in terms of VR application ( n = 13, 54.2%), followed by urology ( n = 8, 33.3%), and gynaecology ( n = 2, 8.3%), as illustrated in Figure 4 .…”

Section: Resultsmentioning

confidence: 99%

“…While all the VR-assisted surgical tool illustrated face and content validity, only 12 (63.2%) exhibited construct validity, thus discriminating clinicians of various levels of expertise [ 11 , 12 , 14 – 17 , 21 , 22 , 26 , 32 , 54 ]. Only one (5.3%) study demonstrated predictive validity, where the VR-assisted training was shown to improve clinicians’ future performance [ 21 ]. However, the study only has a sample size of three, undermining the internal and external validity of its result.…”

Section: Resultsmentioning

confidence: 99%

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Virtual reality and surgical oncology

Ng¹,

Bing²,

Cuevas³

et al. 2023

ecancer

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More than 80% of people diagnosed with cancer will require surgery. However, less than 5% have access to safe, affordable and timely surgery in low-and middle-income countries (LMICs) settings mostly due to the lack of trained workforce. Since its creation, virtual reality (VR) has been heralded as a viable adjunct to surgical training, but its adoption in surgical oncology to date is poorly understood. We undertook a systematic review to determine the application of VR across different surgical specialties, modalities and cancer pathway globally between January 2011 and 2021. We reviewed their characteristics and respective methods of validation of 24 articles. The results revealed gaps in application and accessibility of VR with a proclivity for high-income countries and high-risk, complex oncological surgeries. There is a lack of standardisation of clinical evaluation of VR, both in terms of clinical trials and implementation science. While all VR illustrated face and content validity, only around two-third exhibited construct validity and predictive validity was lacking overall. In conclusion, the asynchrony between VR development and actual global cancer surgery demand means the technology is not effectively, efficiently and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise cost-effective VR technologies with predictive validity for high demand, open cancer surgeries required in LMICs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Virtual reality and surgical oncology

Ng¹,

Bing²,

Cuevas³

et al. 2023

ecancer

View full text Add to dashboard Cite

show abstract

“…This is similar to the present study where there was no difference in the GEARS scores between the two groups of residents. Finally, one study demonstrated that a lengthy training protocol of training for one hour for 60 sessions on a simulator task (Tubes 3) resulted in faster performance of the urethro-vesical anastomosis [24]. However, in that study, there was no other objective assessment of technical skills other than measuring time taken to perform the anastomosis [24].…”

confidence: 99%

Are basic robotic surgical skills transferable from the simulator to the operating room? A randomized, prospective, educational study

Almarzouq

Hu²,

Noureldin³

et al. 2020

CUAJ

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Introduction: We aimed to assess the transferability of basic robotic skills from the simulator to the operating room while performing robotic-assisted radical prostatectomy (RARP) prostatectomy). Methods: Fourteen urology residents were randomized to two groups: group A was required to practice three sessions (nine tasks each) on the simulator, whereas group B was required to practice (same nine tasks) until they reached competency. Both groups were recorded while practicing on the da Vinci Surgical Skills Simulator (da Vinci Simulator). Both groups were then recorded while performing bladder mobilization during RARP. Senior residents from both groups were also recorded while performing urethro-vesical anastomosis during RARP. Recordings were assessed blindly using the validated GEARS tool by C-SATS. Spearman’s correlation coefficient (rho) was used to assess correlation between GEARS scores from practice sessions on the da Vinci Simulator and the GEARS scores from bladder mobilization and urethro-vesical anastomosis during RARP. Results: There was no difference in total GEARS scores between the two groups in the operating room. Total GEARS scores for “ring and rail 2” and “suture sponge” tasks correlated with the total GEARS scores during urethro-vesical anastomosis (rho=0.86, p=0.007; rho=0.90, p=0.002, respectively). GEARS’ efficiency component during “energy and dissection” task on the da Vinci Simulator correlated with GEARS’ efficiency component during bladder mobilization (rho=0.62, p=0.03). GEARS’ force sensitivity component during “ring and rail 2” and “dots and needles” tasks on the da Vinci Simulator correlated with GEARS’ force sensitivity component during bladder mobilization (rho=0.58, p=0.047; rho =0.65, p=0.02, respectively). Conclusions: Objective assessments of urology residents on the da Vinci Surgical Skills Simulator tasks ring and rail 2 and suture sponge correlated with their objective assessments of bladder mobilization and urethro-vesical anastomosis. Therefore, basic robotic skills could be transferred from the simulator to the operating room.

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“…Beyond MIS, the rise of robotics, particularly in urology (Da Vinci systems), has been a major driver for more expensive VR using haptic feedback to mimic the robotic systems [7]. In particular, it has been found that VR appears to improve the learning curve of naïve surgeons performing vesicourethral anastomosis during robot-assisted radical prostatectomy [8].…”

Section: Augmented and Virtual Reality For Surgerymentioning

confidence: 99%

Creating a low-cost virtual reality surgical simulation to increase surgical oncology capacity and capability

Parham¹,

Bing²,

Cuevas³

et al. 2019

ecancer

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Worldwide, more than 80% of people with cancer will require surgery during their disease course, but less than 25% have access to safe, affordable and timely surgery. Among the barriers to increasing surgical capacity are the time and costs required to train novices. Virtual reality (VR) surgical simulations can reduce the time required for novices to reach surgical proficiency, though their costs may exceed USD $100,000. The goal of this study was to determine if a low-cost system, using commercially available technology designed for in-home computer gaming, could be used to create a realistic VR surgical oncology simulation. Standard commercially available VR software and Oculus Rift hardware have been used to provide high-quality visuals and believable surgeon hand interactions. Near identical VR reproduction of an operating room using 1:1 scale matching of real-world elements, including equipment, instruments, supplies and sounds, maintaining frame rate greater than 60 fps to maintain visual fidelity has been created. Internal anatomy was designed as VR replica of human female pelvic anatomy, including organs, veins and other vessels, peritoneum and connective tissue. Internal anatomy was designed to run at 120 fps and to allow for a realistic abdominal radical hysterectomy simulation. Surgical hands were modelled to scale for those with large and small hands. Multiple hand positions were simulated using Oculus touch hardware. Reconstructing the virtual environment to simulate reality as accurately as possible was done to immerse users in the simulator so that they focus on learning and practise without distractions. Training modules were co-designed by experts in learning sciences, human behaviour, VR and gynaecologic oncology. We have successfully created a low-cost VR simulation to help prepare novice surgeons to perform a radical abdominal hysterectomy surgery procedure. The simulation can be used with commercially available computer gaming hardware that currently costs less than USD $1,500. Low-cost VR simulation has the potential to reduce the time and cost to train surgeons to perform surgical oncology procedures, as well as both improve Research

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Predictive Validation of a Robotic Virtual Reality Simulator: The Tube 3 module for Practicing Vesicourethral Anastomosis in Robot-Assisted Radical Prostatectomy

Cited by 14 publications

References 19 publications

Virtual reality and surgical oncology

Virtual reality and surgical oncology

Are basic robotic surgical skills transferable from the simulator to the operating room? A randomized, prospective, educational study

Creating a low-cost virtual reality surgical simulation to increase surgical oncology capacity and capability

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