Proving the Effectiveness of Virtual Reality Simulation for Training in Laparoscopic Surgery

Aggarwal, Rajesh; Ward, Jonnie; Balasundaram, Indran; Sains, Parv; Athanasiou, Thanos; Darzi, Ara

doi:10.1097/sla.0b013e3180f61b09

Cited by 400 publications

(234 citation statements)

References 28 publications

Supporting

Mentioning

221

Contrasting

Unclassified

Order By: Relevance

“…GRS and procedure times on both virtual and benchtop knee models is consistently able to differentiate novice and proficient arthroscopists. Furthermore, our results support current literature showing correlation between [3,5] GRS and motion analysis metrics. To date, there are a plethora of arthroscopic training modalities and measures of performance.…”

Section: Discussionsupporting

confidence: 91%

“…2A-B Built-in motion analysis metrics from the virtual simulator were able to distinguish novice and proficient arthroscopists by overall scores and economy of motion, but not in care with soft tissues. The novice group had lower overall scores in the virtual scope (3 ± 2 [95% CI, 2-4] versus 5 ± 3 [95% CI, [3][4][5][6][7][8], p = 0.018), virtual probe (5 ± 2 [95% CI, 3-6] versus 7 ± 1 [95% CI, 6-8], p = 0.009), and virtual loose-body tasks (4 ± 1 [95% CI, 3-5] versus 6 ± 1 [95% CI, [5][6][7], p = 0.001) (Fig. 3A-B Performance on virtual and benchtop models showed strong correlation based on subjective GRS scores and objective motion analysis metrics, suggesting that subjects performed similarly on both models.…”

Section: Resultsmentioning

confidence: 99%

“…In prior studies, to more accurately assess a learner's arthroscopic proficiency, some authors have limited the observer-subject interaction by using video recordings of hand motion and on-screen displays [3,16]. The latter option may minimize bias and more accurately capture one's true skill but is less practical in day-to-day assessments of learners and therefore we felt live evaluations are more appropriate for assessment of real-life validity.…”

Section: Discussionmentioning

confidence: 99%

“…Similar GRS have been validated outside orthopaedics [3,8,20] and in trauma orthopaedics [18]. [5] were not yet published.…”

Section: Outcome Measuresmentioning

confidence: 99%

See 3 more Smart Citations

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Chang

Banaszek

Gambrel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Work-hour restrictions and fatigue management strategies in surgical training programs continue to evolve in an effort to improve the learning environment and promote safer patient care. In response, training programs must reevaluate how various teaching modalities such as simulation can augment the development of surgical competence in trainees. For surgical simulators to be most useful, it is important to determine whether surgical proficiency can be reliably differentiated using them. To our knowledge, performance on both virtual and benchtop arthroscopy simulators has not been concurrently assessed in the same subjects. Questions/purposes (1) Do global rating scales and procedure time differentiate arthroscopic expertise in virtual and benchtop knee models? (2) Can commercially available built-in motion analysis metrics differentiate arthroscopic expertise? (3) How well are performance measures on virtual and benchtop simulators correlated? (4) Are these metrics sensitive enough to differentiate by year of training? Methods A cross-sectional study of 19 subjects (four medical students, 12 residents, and three staff) were recruited and divided into 11 novice arthroscopists (student to Postgraduate Year [PGY] 3) and eight proficient arthroscopists (PGY 4 to staff) who completed a diagnostic arthroscopy and loose-body retrieval in both virtual and benchtop knee models. Global rating scales (GRS), procedure times, and motion analysis metrics were used to evaluate performance. CI, seconds, p = 0.002). The built-in motion analysis metrics also distinguished novices from proficient arthroscopists using the self-generated virtual loose body retrieval task scores (4 ± 1 [95% CI, 3-5] versus 6 ± 1 [95% CI, 5-7], p = 0.001). GRS scores between virtual and benchtop models were very strongly correlated (q = 0.93, p \ 0.001). There was strong correlation between year of training and virtual GRS (q = 0.8, p \ 0.001) and benchtop GRS (q = 0.87, p \ 0.001) scores. Conclusions To our knowledge, this is the first study to evaluate performance on both virtual and benchtop knee simulators. We have shown that subjective GRS scores and objective motion analysis metrics and procedure time are valid measures to distinguish arthroscopic skill on both virtual and benchtop modalities. Performance on both modalities is well correlated. We believe that training on artificial models allows acquisition of skills in a safe environment. Future work should compare different modalities in the efficiency of skill acquisition, retention, and transferability to the operating room.123 Clin Orthop Relat Res (2016) 474:956-964 DOI 10.1007/s11999-015-4510-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® GRS scales. The proficient subjects completed nearly all tasks faster

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Similar GRS have been validated outside orthopaedics [3,8,20] and in trauma orthopaedics [18]. [5] were not yet published.…”

Section: Outcome Measuresmentioning

confidence: 99%

See 2 more Smart Citations

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Chang

Banaszek

Gambrel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Following training in wet and dry laboratories, several studies have demonstrated improved performance with a significant learning curve [13][14][15][16]. In the current study, the surgeons, in accordance with the Educational Program for LAG at Department of Surgery II, went through an intensive training course consisting of simulator training and at least three sessions of hands-on training with animals, and obtained basic skills by performing laparoscopic cholecystectomies.…”

Section: Discussionmentioning

confidence: 99%

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

et al. 2011

View full text Add to dashboard Cite

Background Laparoscopy-assisted gastrectomy (LAG) is an advanced surgery that requires the mastery of complex surgical skills. We evaluate the feasibility of LAG with systemic lymph node dissection when participating surgeons have sufficient knowledge and experience to conduct open surgery for gastric cancer and basic laparoscopic skills. Methods All operations were performed by two Japan Surgical Society board-certified attending surgeons who had performed over 50 conventional gastrectomies and 30 laparoscopic cholecystectomies. The surgeons went through an established program, including training at the wet and dry laboratories. In addition, surgeries for the first 10 cases were assisted by an expert surgeon with experience of [300 cases. To be eligible for the LAG procedure, patients had to have a preoperative diagnosis of T1, N0 and M0 gastric carcinoma. The morbidity rate was used as the study endpoint. Variables such as operating time, intraoperative blood loss and number of retrieved lymph nodes were evaluated as complementary surgical endpoints. These variables were compared between the first 25 cases and the latter 25 cases.Results A total of 50 patients who were scheduled to undergo LAG were prospectively enrolled between 2005 and 2008. Morbidity rate was 4% (2/50), with one case due to intestinal injury and one case due to an intra-abdominal abscess. Complications related to laparoscopy were observed in 2% (1/50), with one case of mesenteric injury. The conversion rate to laparotomy was 6% (3/50). However, there were no serious consequences in converted cases. The operating time was 263.7 ± 45.0 min. The intraoperative blood loss was 94.5 ± 106.5 g. The total number of regional lymph nodes retrieved was 34.7 ± 12.2. A significant improvement in the blood loss was only noted after the first 25 procedures. All patients are alive and disease-free after a median follow-up of 38.8 months. Conclusion An adequate training program, including site visits by expert surgeons, in conjunction with basic laparoscopy skills and solid backgrounds in open gastrectomy from the perspective of the trainees are currently key to the successful and safe implementation of LAG. Whether the procedure is oncologically feasible remains to be confirmed by long-term follow-up.

show abstract

Single-Incision Laparoscopic Surgery for Cholecystectomy

Chow

Purkayastha²,

Aziz³

et al. 2010

Arch Surg

View full text Add to dashboard Cite

show abstract

Proving the Effectiveness of Virtual Reality Simulation for Training in Laparoscopic Surgery

Cited by 400 publications

References 28 publications

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Single-institute prospective trial of laparoscopy-assisted distal gastrectomy with systemic lymph node dissection for early gastric carcinoma

Single-Incision Laparoscopic Surgery for Cholecystectomy

Contact Info

Product

Resources

About