Surgical Endoscopy (2018) 32:3439–3449
Immersive virtual reality-based training improves response
inasimulated operating room ﬁre scenario
GaneshSankaranarayanan1 · LizzyWooley1· DeborahHogg2· DenisDorozhkin3· JaisaOlasky4·
SanketChauhan1· JamesW.Fleshman1· SuvranuDe3· DanielScott2· DanielB.Jones5
Received: 15 November 2017 / Accepted: 11 January 2018 / Published online: 25 January 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background SAGES FUSE curriculum provides didactic knowledge on OR ﬁre prevention. The objective of this study is
to evaluate the impact of an immersive virtual reality (VR)-based OR ﬁre training simulation system in combination with
Methods The study compared a control with a simulation group. After a pre-test questionnaire that assessed the baseline
knowledge, both groups were given didactic material that consists of a 10-min presentation and reading materials about
precautions and stopping an OR ﬁre from the FUSE manual. The simulation group practiced on the OR ﬁre simulation for
one session that consisted of ﬁve trials within a week from the pre-test. One week later, both groups were reassessed using
a questionnaire. A week after the post-test both groups also participated in a simulated OR ﬁre scenario while their perfor-
mance was videotaped for assessment.
Results A total of 20 subjects (ten per group) participated in this IRB approved study. Median test scores for the control
group increased from 5.5 to 9.00 (p = 0.011) and for the simulation group it increased from 5.0 to 8.5 (p = 0.005). Both groups
started at the same baseline (pre-test, p = 0.529) and reached similar level in cognitive knowledge (post-test, p = 0.853).
However, when tested in the mock OR ﬁre scenario, 70% of the simulation group subjects were able to perform the correct
sequence of steps in extinguishing the simulated ﬁre whereas only 20% subjects in the control group were able to do so
(p = 0.003). The simulation group was better than control group in correctly identifying the oxidizer (p = 0.03) and ignition
source (p = 0.014).
Conclusions Interactive VR-based hands-on training was found to be a relatively inexpensive and eﬀective mode for teaching
OR ﬁre prevention and management scenarios.
Keywords Immersive VR· VR training· Simulation training· OR ﬁre management
Operating room ﬁre have existed from the time when wide-
spread use of combustible anesthetic gases was common.
In an investigation of 230 cases by the American Society
of Anesthetists published in 1941, 36 deaths had been
attributed to operating room (OR) ﬁre at that time . Even
though the incidence of OR ﬁre events has decreased over
time, there are still about 550–650 cases reported each
year, of which 20–30 cases have caused serious injury to
the patients including death. The number of cases is simi-
lar to that of wrong site surgery and generally preventable.
In an analysis of the American Society of Anesthesiolo-
gists closed claims database from 1985 to 2009, there were
103 reported cases of OR ﬁre . Several national organi-
zations have recognized the importance of this sentinel
event and have issued responses. The American Society
and Other Interventional Te
Presented as a poster at the SAGES 2017 annual meeting.
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0046 4-018-6063-x) contains
supplementary material, which is available to authorized users.
* Ganesh Sankaranarayanan
1 Baylor University Medical Center, 3500 Gaston Ave. 1st
Floor Roberts Hospital, Dallas, TX75246, USA
2 UT Southwestern Medical Center, Dallas, TX, USA
3 Rensselaer Polytechnic Institute, Troy, NY, USA
4 Mt Auburn Hospital, Cambridge, MA, USA
5 Beth Israel Deaconess Medical Center, Boston, MA, USA