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Virtual Reality Does Not Meet Expectations in a Pilot Study on Multimodal Laparoscopic Surgery Training

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Abstract

Background

The purpose of the present study was to determine the value of virtual reality (VR) training for a multimodality training program of basic laparoscopic surgery.

Materials and methods

Participants in a two-day multimodality training for laparoscopic surgery used box trainers, live animal training, and cadaveric training on the pulsating organ perfusion (POP) trainer in a structured and standardized training program. The participants were divided into two groups. The VR group (n = 13) also practiced with VR training during the program, whereas the control group (n = 14) did not use VR training. The training modalities were assessed using questionnaires with a five-point Likert scale after the program. Concerning VR training, members of the control group assessed their expectations, whereas the VR group assessed the actual experience of using it. Skills performance was evaluated with five standardized test tasks in a live porcine model before (pre-test) and after (post-test) the training program. Laparoscopic skills were measured by task completion time and a general performance score for each task. Baseline tests were compared with laparoscopic experience of all participants for construct validity of the skills test.

Results

The expected benefit from VR training of the control group was higher than the experienced benefit of the VR group. Box and POP training received better ratings from the VR group than from the control group for some purposes. Both groups improved their skill parameters significantly from pre-training to post-training tests [score +17 % (P < 0.01), time −29 % (P < 0.01)]. No significant difference was found between the two groups for laparoscopic skills improvement except for the score in the instrument coordination task. Construct validity of the skills test was significant for both time and score.

Conclusions

At its current level of performance, VR training does not meet expectations. No additional benefit was observed from VR training in our multimodality training program.

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References

  1. Greene FL, Kercher KW, Nelson H et al (2007) Minimal access cancer management. CA Cancer J Clin 57:130–146

    Article  PubMed  Google Scholar 

  2. Gallagher AG, Ritter EM, Champion H et al (2005) Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 241:364–372

    Article  PubMed  Google Scholar 

  3. Amodeo A, Linares Quevedo A, Jospeh JV et al (2009) Robotic laparoscopic surgery: cost and training. Minerva Urol Nefrol 61:121–128

    PubMed  CAS  Google Scholar 

  4. Madan AK, Frantzides CT (2007) Prospective randomized controlled trial of laparoscopic trainers for basic laparoscopic skills acquisition. Surg Endosc 21:209–213

    Article  PubMed  CAS  Google Scholar 

  5. Gurusamy KS, Aggarwal R, Palanivelu L et al (2009) Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev 2009(1):CD006575

    Google Scholar 

  6. van der Meijden OA, Schijven MP (2009) The value of haptic feedback in conventional and robot-assisted minimal invasive surgery and virtual reality training: a current review. Surg Endosc 23:1180–1190

    Article  PubMed  Google Scholar 

  7. Kenngott HG, Muller-Stich BP, Reiter MA et al (2008) Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol 17:160–167

    Article  PubMed  Google Scholar 

  8. Gurusamy K, Aggarwal R, Palanivelu L et al (2008) Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 95:1088–1097

    Article  PubMed  CAS  Google Scholar 

  9. Jaffer A, Bednarz B, Challacombe B et al (2009) The assessment of surgical competency in the UK. Int J Surg 7:12–15

    Article  PubMed  CAS  Google Scholar 

  10. Aggarwal R, Crochet P, Dias A et al (2009) Development of a virtual reality training curriculum for laparoscopic cholecystectomy. Br J Surg 96:1086–1093

    Article  PubMed  CAS  Google Scholar 

  11. Hart R, Karthigasu K (2007) The benefits of virtual reality simulator training for laparoscopic surgery. Curr Opin Obstet Gynecol 19:297–302

    Article  PubMed  Google Scholar 

  12. Hart R, Karthigasu K, Garry R (2007) Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG 114:656

    Article  PubMed  CAS  Google Scholar 

  13. Vlaovic PD, Sargent ER, Boker JR et al (2008) Immediate impact of an intensive one-week laparoscopy training program on laparoscopic skills among postgraduate urologists. JSLS 12:1–8

    PubMed  Google Scholar 

  14. Wignall GR, Denstedt JD, Preminger GM et al (2008) Surgical simulation: a urological perspective. J Urol 179:1690–1699

    Article  PubMed  Google Scholar 

  15. McDougall EM (2007) Validation of surgical simulators. J Endourol 21:244–247

    Article  PubMed  Google Scholar 

  16. Roberts KE, Bell RL, Duffy AJ (2006) Evolution of surgical skills training. World J Gastroenterol 12:3219–3224

    PubMed  Google Scholar 

  17. van Velthoven RF, Hoffmann P (2006) Methods for laparoscopic training using animal models. Curr Urol Rep 7:114–119

    Article  PubMed  Google Scholar 

  18. Botden SM, Jakimowicz JJ (2009) What is going on in augmented reality simulation in laparoscopic surgery? Surg Endosc 23:1693–1700

    Article  PubMed  Google Scholar 

  19. Palter VN (2011) Comprehensive training curricula for minimally invasive surgery. J Grad Med Educ 3:293–298

    PubMed  Google Scholar 

  20. Clevin L, Grantcharov TP (2008) Does box model training improve surgical dexterity and economy of movement during virtual reality laparoscopy? A randomised trial. Acta Obstet Gynecol Scand 87:99–103

    Article  PubMed  Google Scholar 

  21. Rassweiler J, Klein J, Teber D et al (2007) Mechanical simulators for training for laparoscopic surgery in urology. J Endourol 21:252–262

    Article  PubMed  Google Scholar 

  22. Katz R (2006) Methods of training using pelvic trainers. Curr Urol Rep 7:100–106

    Article  PubMed  Google Scholar 

  23. Panait L, Rafiq A, Tomulescu V et al (2006) Telementoring versus on-site mentoring in virtual reality-based surgical training. Surg Endosc 20:113–118

    Article  PubMed  CAS  Google Scholar 

  24. Undre S, Darzi A (2007) Laparoscopy simulators. J Endourol 21:274–279

    Article  PubMed  Google Scholar 

  25. Sturm LP, Widsor JA, Cosman PH et al (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248:166–179

    Article  PubMed  Google Scholar 

  26. Aggarwal R, Ward J, Balasundaram I et al (2007) Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 246:771–779

    Article  PubMed  Google Scholar 

  27. Schijven MP, Jakimowicz JJ, Broeders IA et al (2005) The Eindhoven laparoscopic cholecystectomy training course—improving operating room performance using virtual reality training: results from the first E.A.E.S. accredited virtual reality trainings curriculum. Surg Endosc 19:1220–1226

    Article  PubMed  CAS  Google Scholar 

  28. Hassan I, Osei-Agyman T, Radu D et al (2008) Simulation of laparoscopic surgery—four years’ experience at the Department of Surgery of the University Hospital Marburg. Wien Klin Wochenschr 120:70–76

    Article  PubMed  Google Scholar 

  29. Xeroulis GJ, Park J, Moulton CA et al (2007) Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 141:442–449

    Article  PubMed  Google Scholar 

  30. Snyder CW, Vandromme MJ, Tyra SL et al (2009) Proficiency-based laparoscopic and endoscopic training with virtual reality simulators: a comparison of proctored and independent approaches. J Surg Educ 66:201–207

    Article  PubMed  Google Scholar 

  31. Oostema JA, Abdel MP, Gould JC (2008) Time-efficient laparoscopic skills assessment using an augmented-reality simulator. Surg Endosc 22:2621–2624

    Article  PubMed  Google Scholar 

  32. Tang B, Hanna GB, Cuschieri A (2005) Analysis of errors enacted by surgical trainees during skills training courses. Surgery 138:14–20

    Article  PubMed  CAS  Google Scholar 

  33. Rosenthal R, Gantert WA, Hamel C et al (2007) Assessment of construct validity of a virtual reality laparoscopy simulator. J Laparoendosc Adv Surg Tech A 17:407–413

    Article  PubMed  Google Scholar 

  34. Rosenthal R, Gantert WA, Hamel C et al (2008) The future of patient safety: surgical trainees accept virtual reality as a new training tool. Patient Saf Surg 2:16

    Article  PubMed  Google Scholar 

  35. Singh PB, Saw NK, Mokete M et al (2008) An integrated laparoscopic simulator (i-Sim) to develop surgical skills outside the operating theatre: a novel means to improve training facilities in the UK. Int J Surg 6:64–70

    Article  PubMed  Google Scholar 

  36. Greene AK, Zurakowski D, Puder M et al (2006) Determining the need for simulated training of invasive procedures. Adv Health Sci Educ Theory Pract 11:41–49

    Article  PubMed  Google Scholar 

  37. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357(9263):1191–1194

    Article  PubMed  CAS  Google Scholar 

  38. Mathis KL, Wiegmann DA (2007) Construct validation of a laparoscopic surgical simulator. Simul Healthc 2:178–182

    Article  PubMed  Google Scholar 

  39. Moorthy K, Munz Y, Dosis F et al (2004) Bimodal assessment of laparoscopic suturing skills: construct and concurrent validity. Surg Endosc 18:1608–1612

    PubMed  CAS  Google Scholar 

  40. van Dongen KW, Tournoij N, van der Zee DC et al (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21:1413–1417

    Article  PubMed  Google Scholar 

  41. Van Sickle KR, Baghai M, Huang IP et al (2008) Construct validity of an objective assessment method for laparoscopic intracorporeal suturing and knot tying. Am J Surg 196:74–80

    Article  PubMed  Google Scholar 

  42. Madan AK, Frantzides TC, Tebbit C et al (2005) Participants’ opinions of laparoscopic training devices after a basic laparoscopic training course. Am J Surg 189:758–761

    Article  PubMed  Google Scholar 

  43. Park A, Witzke D, Donnelly M (2002) Ongoing deficits in resident training for minimally invasive surgery. J Gastrointest Surg 6:501–507 discussion 507-509

    Article  PubMed  Google Scholar 

  44. van Dongen KW, van der Wal WA, Borel Rinkes IHM et al (2008) Virtual reality training for endoscopic surgery: voluntary or obligatory? Surg Endosc 22:664–667

    Article  PubMed  Google Scholar 

  45. Derevianko AY, Schwaltzberg SD, Tsuda S et al (2010) Malpractice carrier underwrites fundamentals of laparoscopic surgery training and testing: a benchmark for patient safety. Surg Endosc 24:616–623

    Article  PubMed  Google Scholar 

  46. Stefanidis D, Korndorffer JR, Markley S et al (2006) Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg 202:599–603

    Article  PubMed  Google Scholar 

  47. Windsor JA, Zoha F (2005) The laparoscopic performance of novice surgical trainees: testing for acquisition, loss, and reacquisition of psychomotor skills. Surg Endosc 19:1058–1063

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors are grateful to Katherine Hughes for revision of the manuscript, and to Thomas Bruckner and Matthias Gondan for statistical advice.

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Correspondence to Felix Nickel.

Additional information

Felix Nickel and Vasile V. Bintintan contributed equally to this study.

Presented at the European Association of Endoscopic Surgery, Geneva, Switzerland, 18th of June 2010.

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Nickel, F., Bintintan, V.V., Gehrig, T. et al. Virtual Reality Does Not Meet Expectations in a Pilot Study on Multimodal Laparoscopic Surgery Training. World J Surg 37, 965–973 (2013). https://doi.org/10.1007/s00268-013-1963-3

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  • DOI: https://doi.org/10.1007/s00268-013-1963-3

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