Skip to main content

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

Obesity Surgery volume 29, pages 1309–1316 (2019)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

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.

References

  1. Arora S, Sevdalis N, Aggarwal R, et al. Stress impairs psychomotor performance in novice laparoscopic surgeons. Surg Endosc. 2010 Oct;24(10):2588–93.

    Article  Google Scholar 

  2. Klein MI, Warm JS, Riley MA, et al. Mental workload and stress perceived by novice operators in the laparoscopic and robotic minimally invasive surgical interfaces. J Endourol. 2012 Aug;26(8):1089–94.

    Article  Google Scholar 

  3. Ma M, Jain LC, Anderson P. Virtual, augmented reality and serious games for healthcare 1. Berlin: Springer; 2014.

    Book  Google Scholar 

  4. Khor WS, Baker B, Amin K, et al. Augmented and virtual reality in surgery—the digital surgical environment: applications, limitations and legal pitfalls. Ann Transl Med. 2016 Dec;4(23):454.

    Article  Google Scholar 

  5. Gebara CM, Barros-Neto TPD, Gertsenchtein L, et al. Virtual reality exposure using three-dimensional images for the treatment of social phobia. Rev Bras Psiquiatr. 2016 Mar;38(1):24–9.

    Article  Google Scholar 

  6. Son JH, Lee SH, Seok JW, et al. Virtual reality therapy for the treatment of alcohol dependence: a preliminary investigation with positron emission tomography/computerized tomography. J Stud Alcohol Drugs. 2015 Jul;76(4):620–7.

    Article  Google Scholar 

  7. Hoffman HG. Virtual-reality therapy. Sci Am. 2004 Aug;291(2):58–65.

    Article  Google Scholar 

  8. García-Betances RI, Arredondo Waldmeyer MT, Fico G, et al. A succinct overview of virtual reality technology use in Alzheimer’s disease. Front Aging Neurosci. 2015 May;7(80):1–8.

    Google Scholar 

  9. Lin CY, Chang YM. Interactive augmented reality using Scratch 2.0 to improve physical activities for children with developmental disabilities. Res Dev Disabil. 2015 Feb;37:1–8.

    CAS  Article  Google Scholar 

  10. Alhabdan S, Alamri H, Aggarwal R. Opportunities for education and training in bariatric surgery: a systematic review. Surg Obes Relat Dis. 2016 Aug;12(7):S147–8.

    Article  Google Scholar 

  11. Pulijala Y, Ma M, Pears M, et al. Effectiveness of immersive virtual reality in surgical training—a randomized control trial. J Oral Maxillofac Surg. 2018 May;76(5):1065–72.

    Article  Google Scholar 

  12. Pourcher G, Ferretti S, Akakpo W, et al. Single-port sleeve gastrectomy for super-obese patients. Surg Obes Relat Dis. 2016 Mar-Apr;12(3):522–7.

    Article  Google Scholar 

  13. Pourcher G, Di Giuro G, Lafosse T, et al. Routine single-port sleeve gastrectomy: a study of 60 consecutive patients. Surg Obes Relat Dis. 2013 May-Jun;9(3):385–9.

    Article  Google Scholar 

  14. Hart SG, Staveland LE. Development of NASA-TLX (task load index): results of empirical and theoretical research. Adv Psychol. 1988;52:139–83.

    Article  Google Scholar 

  15. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377–81.

    CAS  Article  Google Scholar 

  16. Corlett EN, Bishop RP. A technique for assessing postural discomfort. Ergonomics. 1976;19(2):175–82.

    CAS  Article  Google Scholar 

  17. Steuer J. Defining virtual reality: dimensions determining telepresence. J Commun. 1992;42(4):73–93.

    Article  Google Scholar 

  18. Nash EB, Edwards GW, Thompson JA, et al. A review of presence and performance in virtual environments. Int J Hum Comput Interact. 2000;12(1):1–41.

    Article  Google Scholar 

  19. Mantovani F, Castelnuovo G. The sense of presence in virtual training: enhancing skills acquisition and transfer of knowledge through learning experience in virtual environments. In: Riva G, Davide F, IJsselsteijn WA, editors. Being there: concepts, effects and measurement of user presence in synthetic environments. Amsterdam, Netherland: Ios Press; 2003. p. 168–81.

    Google Scholar 

  20. Witmer BG, Singer MJ. Measuring presence in virtual environments: a presence questionnaire. Presence. 1998;7(3):225–40.

    Article  Google Scholar 

  21. Hill KJ, Howarth PA. Habituation to the side effects of immersion in a virtual environment. Displays. 2000;21(1):25–30.

    Article  Google Scholar 

  22. Nichols S, Patel H. Health and safety implications of virtual reality: a review of empirical evidence. Appl Ergon. 2002;33(3):251–71.

    Article  Google Scholar 

  23. Kennedy RS, Lane NE, Berbaum KS, et al. Simulator sickness questionnaire: an enhanced method for quantifying simulator sickness. Int J Aviat Psychol. 1993;3(3):203–20.

    Article  Google Scholar 

  24. Brooke J. SUS-A quick and dirty usability scale. Usability evaluation in industry. 1996;189(194):4–7.

    Google Scholar 

  25. Azmandian M, Hancock M, Benko H, et al. Haptic retargeting: dynamic repurposing of passive haptics for enhanced virtual reality experiences. Proceedings of the CHI’16 conference on human factors in computing systems. 2016:1968–79.

  26. Shewaga R, Uribe-Quevedo A, Kapralos B, et al. Comparison of seated and room-scale virtual reality in a serious game for epidural preparation. In: IEEE transactions on emerging topics in computing; 2017. p. 1–14.

    Google Scholar 

  27. Byers JC, Bittner AC, Hill SG. Traditional and raw task load index (TLX) correlations: are paired comparisons necessary? In: Mital A, editor. Advances in industrial ergonomics and safety. London: Taylor & Francis; 1989. p. 481–5.

    Google Scholar 

  28. Bouchard S, Robillard G, Renaud P, et al. Exploring new dimensions in the assessment of virtual reality induced side effects. J Comput Inf Technol. 2011;1(3):20–32.

    Google Scholar 

  29. Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: adding an adjective rating scale. J Usability Stud. 2009;4(3):114–23.

    Google Scholar 

  30. Rosen KR. The history of medical simulation. J Crit Care. 2008 Jun;23(2):157–66.

    Article  Google Scholar 

  31. Moorthy K, Munz Y, Forrest D, et al. Surgical crisis management skills training and assessment: a stimulation-based approach to enhancing operating room performance. Ann Surg. 2006 Jul;244(1):139–47.

    Article  Google Scholar 

  32. Chang TP, Gerard J, Pusic MV. Screen-based simulation, virtual reality, and haptic simulators. In: Grant VJ, Cheng A, editors. Comprehensive healthcare simulation: pediatrics: Springer; 2016. p. 105–14.

  33. Yiannakopoulou E, Nikiteas N, Perrea D, et al. Virtual reality simulators and training in laparoscopic surgery. Int J Surg. 2015 Jan;13:60–4.

    Article  Google Scholar 

  34. Botden SM, Jakimowicz JJ. What is going on in augmented reality simulation in laparoscopic surgery? Surg Endosc. 2009 Aug;23(8):1693–700.

    Article  Google Scholar 

  35. Huber T, Paschold M, Hansen C, et al. New dimensions in surgical training: immersive virtual reality laparoscopic simulation exhilarates surgical staff. Surg Endosc. 2017 Nov;31(11):4472–7.

    Article  Google Scholar 

  36. Huber T, Wunderling T, Paschold M, et al. Highly immersive virtual reality laparoscopy simulation: development and future aspects. Int J Comput Assist Radiol Surg. 2018 Feb;13(2):281–90.

    Article  Google Scholar 

  37. Zheng B, Jiang X, Tien G, et al. Workload assessment of surgeons: correlation between NASA TLX and blinks. Surg Endosc. 2012 Oct;26(10):2746–50.

    Article  Google Scholar 

  38. Elhage O, Challacombe B, Shortland A, et al. An assessment of the physical impact of complex surgical tasks on surgeon errors and discomfort: a comparison between robot-assisted, laparoscopic and open approaches. BJU Int. 2015 Feb;115(2):274–81.

    Article  Google Scholar 

  39. Paige JT, Yu Q, Hunt JP, et al. Thinking it through: mental rehearsal and performance on 2 types of laparoscopic cholecystectomy simulators. J Surgical Educ. 2015 Jul-Aug;72(4):740–8.

    Article  Google Scholar 

Download references

Author information

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

Authors
  1. Jessy Barré
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daphné Michelet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Truchot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erwan Jolivet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Recanzone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sabrina Stiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Antoine Tesnière
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Guillaume Pourcher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessy Barré.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

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.

Informed Consent Statement

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

Additional information

Publisher’s Note

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-03680-9

Keywords

  • Single port
  • Sleeve
  • Obesity
  • Learning
  • Simulation
  • Virtual reality
  • Human factors