Virtual reality training improves operating room performance: Results of a randomized, double-blinded study

Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
Annals of Surgery (Impact Factor: 8.33). 10/2002; 236(4):458-63; discussion 463-4. DOI: 10.1097/01.SLA.0000028969.51489.B4
Source: PubMed


To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment.
The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study.
Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80).
No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test).
The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Download full-text


Available from: Dana Andersen
  • Source
    • "They provide objective and automated measurement of performance, which can improve the evaluation process [11]. Furthermore, they can be designed to provide haptic feedback, an essential component for training minimally invasive surgery skills [10] [12] [13] [14] [15] [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The Fundamentals of Laparoscopic Surgery (FLS) trainer is currently the standard for training and evaluating basic laparoscopic skills. However, its manual scoring system is time-consuming and subjective. The Virtual Basic Laparoscopic Skill Trainer (VBLaST©) is the virtual version of the FLS trainer which allows automatic and real time assessment of skill performance, as well as force feedback. In this study, the VBLaST© pattern cutting (VBLaST-PC©) and ligating loop (VBLaST-LL©) tasks were evaluated as part of a validation study. We hypothesized that performance would be similar on the FLS and VBLaST© trainers, and that subjects with more experience would perform better than those with less experience on both trainers. Methods: Fifty-five subjects with varying surgical experience were recruited at the Learning Center during the 2013 SAGES annual meeting and were divided into two groups: experts (PGY 5, surgical fellows and surgical attendings) and novices (PGY 1-4). They were asked to perform the PC or the ligating loop task on the FLS and the VBLaST© trainers. Their performance scores for each trainer were calculated and compared. Results: There were no significant differences between the FLS and VBLaST© scores for either the PC or the ligating loop task. Experts' scores were significantly higher than the scores for novices on both trainers. Conclusion: This study showed that the subjects' performance on the VBLaST© trainer was similar to the FLS performance for both tasks. Both the VBLaST-PC© and the VBLaST-LL© tasks permitted discrimination between the novice and expert groups. Although concurrent and discriminant validity has been established, further studies to establish convergent and predictive validity are needed. Once validated as a training system for laparoscopic skills, the system is expected to overcome the current limitations of the FLS trainer.
    Full-text · Article · Aug 2014 · Surgical Endoscopy
  • Source
    • "Vozenilek et al. neatly capture the significance and potential of simulation-based medical training by reforming the old dictum, " See one, do one, teach one " to become, " See one, simulate many, do one competently, and teach everyone " (Vozenilek, Huff et al. 2004). As the effectiveness of simulation is demonstrated (Seymour, Gallagher et al. 2002, Abrahamson, Denson et al. 2004, Grantcharov, Kristiansen et al. 2004, Barry- Issenberg, McGaghie et al. 2005), acceptance of simulation-based training will increase. 2 VR Medical Simulations: The State of the Art VR simulation has come a long way in the past decade, and has now reached a point where it has been demonstrated to effectively improve learning outcomes in clinical settings (Seymour 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Virtual reality (VR) medical simulations deliver a tailored learning experience that can be standardized, and can cater to different learning styles in ways that cannot be matched by traditional teaching. These simulations also facilitate self-directed learning, allow trainees to develop skills at their own pace and allow unlimited repetition of specific scenarios that enable them to remedy skills deficiencies in a safe environment. A number of simulators have been validated and have shown clear benefits to medical training. However, while graphical realism is high, realistic haptic feedback and interactive tissues are limited for many simulators. This paper reviews the current status and benefits of haptic VR simulation-based medical training for bone and dental surgery, intubation procedures, eye surgery, and minimally invasive and endoscopic surgery.
    Full-text · Article · Jul 2014 · Journal of Simulation
    • "Importantly, there was also significant improvement in the performance of fatigued groups. Such data have spurred the development of surgical simulators to help trainees practice and refine surgical procedures.[111220] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Since its introduction, there have been many refinements in the technique and implementation of robotic-assisted radical prostatectomy (RARP). However, it is unclear whether operative outcomes are influenced by surgical case order. We evaluated the effect of case order on perioperative outcomes for RARP within a large health maintenance organization. We conducted a retrospective review of RARP cases performed at our institution from September 2008 to December 2010 using a single robotic platform. Case order was determined from surgical schedules each day and surgeries were grouped into 1(st), 2(nd) and 3(rd) round cases. Fourth round cases (n = 1) were excluded from analysis. We compared clinicopathological variables including operative time, estimated blood loss (EBL), surgical margin rates and complication rates between groups. Of the 1018 RARP cases in this cohort, 476 (47%) were performed as 1(st) round cases, 398 (39%) 2(nd) round cases and 144 (14%) 3(rd) round cases by a total of 18 surgeons. Mean operative time was shorter as cases were performed later in the day (213 min vs. 209 min vs. 180 min, P < 0.0001) and similarly, EBL also decreased with surgical order (136 mL vs. 134 mL vs. 103 mL, P = 0.01). Transfusion rates, surgical margin rates and complication rates did not significantly differ between groups. Patients undergoing RARP later in the day were much more likely to have a hospital stay of 2 or more days than earlier cases (10% vs. 11% vs. 32%, P = 0.01). Surgical case order may influence perioperative outcomes for RARP with decreased operative times and increased length of hospital stay associated with later cases. These findings indicate that select perioperative factors may improve with ascending case order as the surgical team "warms up" during the day. In addition, 3(rd) round cases can increase hospital costs associated with increased lengths of hospital stay. Knowledge of these differences may assist in surgical planning to improve outcomes and limit costs.
    No preview · Article · Apr 2014 · Urology Annals
Show more