Skip to main content
SpringerLink
Log in

Face, content, and construct validity of a novel VR/AR surgical simulator of a minimally invasive spine operation

  • Original Article
  • Published:
Medical & Biological Engineering & Computing Aims and scope Submit manuscript

Abstract

Mixed-reality surgical simulators are seen more objective than conventional training. The simulators’ utility in training must be established through validation studies. Establish face-, content-, and construct-validity of a novel mixed-reality surgical simulator developed by McGill University, CAE-Healthcare, and DePuy Synthes. This study, approved by a Research Ethics Board, examined a simulated L4-L5 oblique lateral lumbar interbody fusion (OLLIF) scenario. A 5-point Likert scale questionnaire was used. Chi-square test verified validity consensus. Construct validity investigated 276 surgical performance metrics across three groups, using ANOVA, Welch-ANOVA, or Kruskal–Wallis tests. A post-hoc Dunn’s test with a Bonferroni correction was used for further analysis on significant metrics. Musculoskeletal Biomechanics Research Lab, McGill University, Montreal, Canada. DePuy Synthes, Johnson & Johnson Family of Companies, research lab. Thirty-four participants were recruited: spine surgeons, fellows, neurosurgical, and orthopedic residents. Only seven surgeons out of the 34 were recruited in a side-by-side cadaver trial, where participants completed an OLLIF surgery first on a cadaver and then immediately on the simulator. Participants were separated a priori into three groups: post-, senior-, and junior-residents. Post-residents rated validity, median > 3, for 13/20 face-validity and 9/25 content-validity statements. Seven face-validity and 12 content-validity statements were rated neutral. Chi-square test indicated agreeability between group responses. Construct validity found eight metrics with significant differences (p < 0.05) between the three groups. Validity was established. Most face-validity statements were positively rated, with few neutrally rated pertaining to the simulation’s graphics. Although fewer content-validity statements were validated, most were rated neutral (only four were negatively rated). The findings underscored the importance of using realistic physics-based forces in surgical simulations. Construct validity demonstrated the simulator’s capacity to differentiate surgical expertise.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Goldenberg M, Lee JY (2018) Surgical education, simulation, and simulators-updating the concept of validity. Curr Urol Rep 19(7):52. https://doi.org/10.1007/s11934-018-0799-7

    Article  PubMed  Google Scholar 

  2. Pfandler M, Lazarovici M Stefan P, Wucherer P, and Weigl M (2017) Virtual reality-based simulators for spine surgery: a systematic review. Spine J 17. https://doi.org/10.1016/j.spinee.2017.05.016

  3. Vaughan N (2016) A review of virtual reality based training simulators for orthopaedic surgery. Med Eng Phys 38(2):59

    Article  PubMed  Google Scholar 

  4. El-Monajjed K and Driscoll M (2020) Analysis of surgical forces required to gain access using a probe for minimally invasive spine surgery via cadaveric-based experiments towards use in training simulators. IEEE Trans Biomed Eng 1. https://doi.org/10.1109/TBME.2020.2996980

  5. McGill University to partner with industry in developing virtual-reality training platform for spinal surgery (2018). Available: https://www.mcgill.ca/newsroom/channels/news/mcgill-university-partner-industry-developing-virtual-reality-training-platform-spinal-surgery-287588

  6. Alkadri S (2018) Kinematic study and layout design of a haptic device mounted on a spine bench model for surgical training. Mechanical Engineering, McGill University, Undergraduate Honours Program - Mechanical Engineering

    Google Scholar 

  7. Ledwos N, Mirchi N, Bissonnette V, Winkler-Schwartz A, Yilmaz R, Del Maestro RF (2020) Virtual reality anterior cervical discectomy and fusion simulation on the novel sim-ortho platform: validation studies. Oper Neurosurg 20(1):74–82

    Article  Google Scholar 

  8. Cotter T, Mongrain T, Driscoll M (2022) Design synthesis of a robotic uniaxial torque device for orthopedic haptic simulation. J Med Devices 16(3):031008. https://doi.org/10.1115/1.4054344

  9. Patel S, Ouellet J, Driscoll M (2023) Examining impact forces during posterior spinal fusion to implement in a novel physics-driven virtual reality surgical simulator. Med Biol Eng Comput 61:1837–1843. https://doi.org/10.1007/s11517-023-02819-w

  10. Mirchi N et al (2019) Artificial neural networks to assess virtual reality anterior cervical discectomy performance. Operative Neurosurg 19(1):65–75. https://doi.org/10.1093/ons/opz359

    Article  Google Scholar 

  11. Munz Y (2004) Laparoscopic virtual reality and box trainers: is one superior to the other?  Surgical Endoscopy 18(3):485

    Article  CAS  PubMed  Google Scholar 

  12. Carter FJ et al (2005) Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc Other Interv Techn 19(12):1523–1532. https://doi.org/10.1007/s00464-005-0384-2

    Article  CAS  Google Scholar 

  13. Huang C, Cheng H, Bureau Y, Ladak HM, Agrawal SK (2018) Automated metrics in a virtual-reality myringotomy simulator: development and construct validity. Otol Neurotol 39(7). https://doi.org/10.1097/mao.0000000000001867

  14. Kwasnicki RM, Aggarwal R, Lewis TM, Purkayastha S, Darzi A, Paraskeva PA (2013) A comparison of skill acquisition and transfer in single incision and multi-port laparoscopic surgery. J Surg Educ 70(2):172–179. https://doi.org/10.1016/j.jsurg.2012.10.001

    Article  PubMed  Google Scholar 

  15. Stew B, Kao ST, Dharmawardana N, Ooi EH (2018) A systematic review of validated sinus surgery simulators. Clin Otolaryngol 43(3):812–822. https://doi.org/10.1111/coa.13052

    Article  CAS  PubMed  Google Scholar 

  16. Chawla S, Devi S, Calvachi P, Gormley WB, Rueda-Esteban R (2022) Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review. Acta Neurochir 164(4):947–966. https://doi.org/10.1007/s00701-021-05003-x

    Article  PubMed  Google Scholar 

  17. Van Nortwick SS, Lendvay TS, Jensen AR, Wright AS, Horvath KD, Kim S (2010) Methodologies for establishing validity in surgical simulation studies. Surgery 147(5):622–630. https://doi.org/10.1016/j.surg.2009.10.068

    Article  PubMed  Google Scholar 

  18. Søvik O et al (2023) Virtual reality simulation training in stroke thrombectomy centers with limited patient volume—simulator performance and patient outcome. Interv Neuroradiol. https://doi.org/10.1177/15910199231198275

  19. Chen JY, Thropp JE (2007) Review of low frame rate effects on human performance. IEEE 37(6):1063–1076

    Google Scholar 

  20. Card SK (2018) The psychology of human-computer interaction. Crc Press

    Book  Google Scholar 

Download references

Funding

NSERC Collaborative Research Development (CRD) Grant, Franco Di Giovanni Foundation, Brain Tumour Foundation of Canada Brain Tumour Research Grant, a Medical Education Research Grant from the Royal College of Physicians and Surgeons of Canada, and the Montreal Neurological Institute and Hospital.

Author information

Authors and Affiliations

  1. Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Macdonald Engineering Building, 815 Sherbrooke St W, Montreal, QC, H3A 2K7, Canada

    Sami Alkadri & Mark Driscoll

  2. Orthopaedic Research Lab, Montreal General Hospital, 1650 Cedar Ave (LS1.409), Montreal, QC, H3G 1A4, Canada

    Mark Driscoll

  3. Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, 2200 Leo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada

    Sami Alkadri & Rolando F. Del Maestro

Authors
  1. Sami Alkadri
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rolando F. Del Maestro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark Driscoll
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Driscoll.

Ethics declarations

Ethical approval

The institutional IRB approval was received for the study protocol and consent forms. This research involved recruiting surgeons to perform the virtual surgery on the simulator. Proper consent was obtained.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alkadri, S., Del Maestro, R.F. & Driscoll, M. Face, content, and construct validity of a novel VR/AR surgical simulator of a minimally invasive spine operation. Med Biol Eng Comput (2024). https://doi.org/10.1007/s11517-024-03053-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11517-024-03053-8

Keywords

Search

Navigation