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Virtual Reality Single-Port Sleeve Gastrectomy Training Decreases Physical and Mental Workload in Novice Surgeons: An Exploratory Study

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Abstract

Background

Novice surgeons experience high levels of physical and mental workload during the early stages of their curriculum and clinical practice. Laparoscopic sleeve gastrectomy is the first bariatric procedure worldwide. Feasibility and safety of single-port sleeve gastrectomy (SPSG) has been demonstrated. An immersive virtual reality (VR) simulation was developed to provide a repetitive exercise to learn this novel technique. The primary objective of this study was to evaluate the impact of the VR training tool on mental and physical workload in novice surgeons. The secondary objective included an evaluation of the VR simulator.

Methods

A monocentric-controlled trial was conducted. Ten participants were divided into two groups, the VR group and the control group (without VR training). Surgery residents participated in a first real case of SPSG and a second case 1 month later. The VR group underwent a VR training between the two surgeries. Mental and physical loads were assessed with self-assessment questionnaires: NASA-TLX, Borg scale, and manikin discomfort test. The VR simulator was evaluated through presence, cybersickness, and usability questionnaires.

Results

This study showed a decrease of the mental demand and effort dimensions of NASA-TLX between the first and the second surgery in the VR group (P < .05). During the second surgery, a marginally significant difference was shown concerning the mental demand between the two groups. Postural discomfort of the VR group decreased with practice (P < .01), mainly between the first and the second surgery (P < .05). Furthermore, participants characterized the VR simulator as realistic, usable, and very useful to learned surgery.

Conclusion

This exploratory study showed an improvement in mental and physical workload when novice surgeons trained with VR (repetitive practice, gesture improvement, reduction of stress, etc.). Virtual reality appears to be a promising perspective for surgical training.

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Notes

  1. In NASA-TLX, performance is the only dimension with an inverse range, the scale going from good (0) to poor (100), while in other dimensions, the scale going from low (0) to high (100). RTLX score was used in this study [27].

  2. Postural discomfort score is based on manikin body part of Corlett and Bishop [16]. Here, the score range from 0 to 10, with 0 being none discomfort and 10 extreme discomfort.

  3. The PQ measure is divided in seven categories: realism (seven questions), possibility to act/control (four questions), quality of interface (three questions), possibility to examine (three questions), self-efficacy/performance (two questions), sounds (not evaluated here), and haptic (two questions). The questionnaire contains 21 items and is measured through an 8-point semantic differential scale (e.g., from “not at all” to “completely”).

  4. Augmented reality (AR) & virtual reality (VR) in Healthcare Market Report, 2025. Available from https://www.grandviewresearch.com/industry-analysis/virtual-reality-vr-in-healthcare-market.

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Authors and Affiliations

  1. Ilumens, Université Paris Descartes, 45 Rue des Saints-Pères, 75006, Paris, France

    Jessy Barré, Daphné Michelet, Antoine Tesnière & Guillaume Pourcher

  2. Department of Anesthesia, Robert Debré Hospital, 48 boulevard Sérurier, Paris, 75019, France

    Daphné Michelet

  3. Ilumens, Université Paris Diderot, 20 Rue du Département, 75018, Paris, France

    Jennifer Truchot

  4. Emergency department, Lariboisière Hospital, 2 Rue Ambroise Paré, Paris, 75010, France

    Jennifer Truchot

  5. VirtualiSurg, 171 bis Avenue Charles de Gaulle, 92200, Neuilly-sur-Seine, France

    Erwan Jolivet, Thomas Recanzone, Sabrina Stiti & Guillaume Pourcher

  6. Department of Anaesthesia and Intensive Care, George Pompidou European Hospital, 20 Rue Leblanc, Paris, 75015, France

    Antoine Tesnière

  7. Centre de prise en charge de la maladie obésité, Département digestif, Institut mutualiste Montsouris, 42 boulevard Jourdan, 75014, Paris, France

    Guillaume Pourcher

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  1. Jessy Barré
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Correspondence to Jessy Barré.

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Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Barré, J., Michelet, D., Truchot, J. et al. Virtual Reality Single-Port Sleeve Gastrectomy Training Decreases Physical and Mental Workload in Novice Surgeons: An Exploratory Study. OBES SURG 29, 1309–1316 (2019). https://doi.org/10.1007/s11695-018-03680-9

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