Virtual reality simulators and training in laparoscopic surgery

Background/Aim: Peritonitis rates in peritoneal dialysis (PD) vary considerably not only across countries but also between centers in the same country. Patient education has been shown to significantly reduce infection rates but up till now training lacks standardization with patients being trained using different methods and media (e.g., illustrations, videos). As a result, patients may be insufficiently experienced in performing PD, which might be one of the causes for high peritonitis rates. To address these issues, we developed a PD training program based on virtual reality (VR). Methods: To become acquainted with the PD procedure, patients are equipped with a VR headset and controllers. They are presented with a virtual PD set, which simulates the feeling of sitting in front of a real PD set. The patient is enabled to run through the program as often as necessary to become familiarized with the whole PD procedure. The aim is to standardize, facilitate, and accelerate the individual learning process. To compare the effect of the applied training method to traditional training, a randomized controlled trial is underway. Conclusion: Previous studies on the effectiveness of learning showed that VR training applications are superior to traditional methods, such as text- or video-based training. However, no study has been undertaken in the context of dialysis. We believe that the implementation of VR training programs in clinical practice will be beneficial in improving the patient’s proficiency, and thereby the quality and safety of PD.

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“…Yiannakopoulou et al [19] evaluated VR training programs as beneficial based on Kirkpatrik's 4-level model. The levels are as follows:…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era

Zgoura

Hettich²,

Natzel³

et al. 2018

Blood Purif

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“…Conversely, further research is still needed to investigate the effect of VR simulators on the performance of advanced laparoscopic procedures, and patient outcomes. 1,11 Additionally, the costs of VR simulation are considerable and need to be weighed with other alternatives, depending on the available budget. For example, according to a study published in 2007, a box trainer with electrocautery and endoscopic clip applier costs around $30 000 (€26 412) (without taking into account the costs of organ purchase, preparation and expert supervision) and a VR training simulator costs between $50 000 (€44 019) and $87 000 (€76 593).…”

Section: Discussionmentioning

confidence: 99%

“…7 Therefore, alternative methods have been developed for training laparoscopy outside of the OR such as box trainers, animal models, and virtual reality (VR) simulation. 1 VR simulation has been used to train and assess surgical skills (using objective performance indicators) in a relaxed environment outside the OR, without exposing patients to unnecessary risks and without the need of supervision. 8 However, studies suggest that VR simulation alone is not as effective as traditional training for certain procedures (e.g.…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality Simulation as a Tool to Monitor Surgical Performance Indicators: VIRESI Observational Study

et al. 2017

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A mediana do 'tempo total' necessário para completar a tarefa diminuiu significativamente (p < 0,05) de 759,5 para 523,5 segundos. Verificámos uma diminuição significativa (p < 0,05) nas medianas dos indicadores 'tempo total de carregar a agulha no porta-agulhas' (303,3 para 107,8 segundos), 'tempo médio de carregamento da agulha' (38,5 para 31,0 segundos), 'número de passagens em que a agulha passou precisamente através dos pontos de entrada' (2,5 para 1,0), 'tempo em que a agulha foi manipulada fora do campo de visão' (20,9 para 2,4 segundos), e 'tempo total em que as extremidades dos porta-agulhas foram mantidas fora do campo operatório' (88,2 para 49,6 segundos). Discussão: Este estudo mostra o potencial da realidade virtual servir como ferramenta para a avaliação do desempenho cirúrgico dos cirurgiões portugueses. Conclusão: O simulador de realidade virtual LAP Mentor tem a capacidade de identificar variações em indicadores de desempenho cirúrgico de anastomose digestiva. Palavras-chave: Anastomose Cirúrgica; Laparoscopia/educação; Portugal; Treino de Simulação ABSTRACT Introduction: Virtual reality simulation is a topic of discussion as a complementary tool to traditional laparoscopic surgical training in the operating room. However, it is unclear whether virtual reality training can have an impact on the surgical performance of advanced laparoscopic procedures. Our objective was to assess the ability of the virtual reality simulator LAP Mentor to identify and quantify changes in surgical performance indicators, after LAP Mentor training for digestive anastomosis. Material and Methods:Twelve surgeons from Centro Hospitalar de São João in Porto (Portugal) performed two sessions of advanced task 5: anastomosis in LAP Mentor, before and after completing the tutorial, and were evaluated on 34 surgical performance indicators. Results:The results show that six surgical performance indicators significantly changed after LAP Mentor training. The surgeons performed the task significantly faster as the median 'total time' significantly reduced (p < 0.05) from 759.5 to 523.5 seconds. Significant decreases (p < 0.05) were also found in median 'total needle loading time' (303.3 to 107.8 seconds), 'average needle loading time' (38.5 to 31.0 seconds), 'number of passages in which the needle passed precisely through the entrance dots' (2.5 to 1.0), 'time the needle was held outside the visible field' (20.9 to 2.4 seconds), and 'total time the needle-holders' ends are kept outside the predefined operative field' (88.2 to 49.6 seconds). Discussion: This study raises the possibility of using virtual reality training simulation as a benchmark tool to assess the surgical performance of Portuguese surgeons. Conclusion: LAP Mentor is able to identify variations in surgical performance indicators of digestive anastomosis.

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“…However, harvested tissue models provide the operation without perfusion, require special facilities for storage and are used only for limited procedures. 8,[11][12][13][14][15] The hybrid trainers combine virtual-reality with video-box simulation, guide on how to perform entire operation, promote team based training, provide realistic haptic feedback as actual surgery and give metrics without the need of the presence of an experienced surgeon in order to give the trainee feedback. Nonetheless, hybrid trainers are not portable and require facility, time and effort in preparation and maintenance.…”

Section: Simulator Typesmentioning

confidence: 99%

Striving for Better Medical Education: the Simulation Approach

et al. 2017

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Medical simulation is a rapidly expanding area within medical education due to advances in technology, significant reduction in training hours and increased procedural complexity. Simulation training aims to enhance patient safety through improved technical competency and eliminating human factors in a risk free environment. It is particularly applicable to a practical, procedure-orientated specialties.Simulation can be useful for novice trainees, experienced clinicians (e.g. for revalidation) and team building. It has become a cornerstone in the delivery of medical education, being a paradigm shift in how doctors are educated and trained. Simulation must take a proactive position in the development of metric-based simulation curriculum, adoption of proficiency benchmarking definitions, and should not depend on the simulation platforms used.Conversely, ingraining of poor practice may occur in the absence of adequate supervision, and equipment malfunction during the simulation can break the immersion and disrupt any learning that has occurred. Despite the presence of high technology, there is a substantial learning curve for both learners and facilitators.The technology of simulation continues to advance, offering devices capable of improved fidelity in virtual reality simulation, more sophisticated procedural practice and advanced patient simulators. Simulation-based training has also brought about paradigm shifts in the medical and surgical education arenas and ensured that the scope and impact of simulation will continue to broaden.

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Virtual reality simulators and training in laparoscopic surgery

Cited by 173 publications

References 50 publications

Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era

Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era

Virtual Reality Simulation as a Tool to Monitor Surgical Performance Indicators: VIRESI Observational Study

Striving for Better Medical Education: the Simulation Approach

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