Deliberate Practice on a Virtual Reality Laparoscopic Simulator Enhances the Quality of Surgical Technical Skills

Abstract Aims Excellent surgical technical skills are of paramount importance to perform surgical procedures, safely and efficiently. Virtual reality surgical simulators can both simulate real operations while providing standardized, risk-free surgical hands-on experience. The integration of AI (artificial intelligence) and virtual reality simulators provides opportunities to carry out comprehensive continuous assessments of surgical performance. We developed and tested a deep learning algorithm which can continuously monitor and assess surgical bimanual performance on virtual reality surgical simulators. Methods Fifty participants from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed a simulated subpial tumor resection 5 times and a complex simulated brain tumor operation once on the NeuroVR platform. Participants were asked to remove the tumors completely while minimizing bleeding and damage to surrounding tissues employing a simulated ultrasonic aspirator and bipolar forceps. A deep neural network continually tracked the surgical performance utilizing 16 performance metrics generated every 0.2-seconds. Results The deep neural network was successfully trained using neurosurgeons and medical students’ data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm was able to score the technical skills of individuals continuously at 0.2-second intervals. Statistically significant differences in average scores were identified between the 4 groups. Conclusions AI-powered surgical simulators provide continuous assessment of bimanual technical skills during surgery which may further define the composites necessary to train surgical expertise. To our knowledge, this is the first attempt in surgery to continuously assess surgical technical skills using deep learning.

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Improving Neurosurgery Resident Microdissection Through Placental Simulation

Neurosurgery Open ◽

10.1093/neuopn/okab026 ◽

2021 ◽

Vol 2 (4) ◽

Author(s):

Nicolas E Alcalá ◽

Hengameh B Pajer ◽

Martin Piazza ◽

William Goodnight ◽

Edward Yap ◽

...

Keyword(s):

Deliberate Practice ◽

Handling Time ◽

Technical Skills ◽

Realistic Model ◽

Prior Work ◽

Aneurysm Clipping ◽

Time Flow ◽

Tissue Microdissection ◽

Informal Feedback

ABSTRACT Prior work has shown that the human placenta is an available and realistic model for microdissection simulation. We sought to find a measurable improvement in the technical skills of neurosurgical residents with deliberate practice of microdissection tasks using a placental model. Postgraduate year (PGY) 1 to 3 neurosurgery residents were consented. A 1-min video of each participant's baseline skills skeletonizing placental vessels was recorded. Participants underwent 10 practice sessions with intermittent informal feedback for 30-60 min over 18 mo. Another 1-min video was recorded following the 10th dissection. The videos were blinded and assessed by 3 board eligible or certified microsurgical neurosurgeons using a modified Objective Structured Assessment of Aneurysm Clipping Skills. Performance was compared via t-testing among four domains: instrument handling, time flow and forward planning, quality of dissection, and respect for tissue. Microdissection, instrument handling, and quality of dissection were significantly improved after deliberate practice with the placental simulator (P < .05). Improvement was seen in time flow and forward planning and respect for tissue; however, this failed to be significant. Subjectively, residents expressed enjoyment performing the exercise. They also expressed a desire for demonstrations or videos to watch before practice sessions. The placental simulation model provides microsurgical skill development with minimal deliberate practice sessions. Practice exercises are favorably regarded and interest in continuing them is strong by residents. Residents expressed a desire to make the dissection more deliberate with demonstration, breakdown of steps, and mimicry, which could improve the effectiveness and enjoyment of the skills session.

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56. Proficiency at the end of practice predicts retention of a technical clinical skills

Clinical & Investigative Medicine ◽

10.25011/cim.v30i4.2817 ◽

2007 ◽

Vol 30 (4) ◽

pp. 59

Author(s):

H. Carnahan ◽

E. Hagemann ◽

A. Dubrowski

Keyword(s):

Virtual Reality ◽

Clinical Skills ◽

Clinical Skill ◽

Technical Skills ◽

Skills Training ◽

Retention Performance ◽

Specific Criterion ◽

Practice Trials ◽

Practice Time ◽

Criterion Time

A debate is emerging regarding the efficacy of proficiency based versus duration based training of technical skills. It is not clear whether the performance level attained at the end of practice (i.e., proficiency criteria), or the overall amount of practice performed during learning will best predict the retention of a technical clinical skill. The skill learned was the single-handed double square-knot. Forty two trainees learned the skill through video-based instruction and were divided into three groups (14 participants per group) each with a specific criterion time to tie the knot (10, 15, and 20 seconds). Practice continued until participants completed the knot within their criterion time. The total number of trials, and the overall practice time required to obtain each respective criterion were recorded during practice. Participants returned one-week later for a timed retention test consisting of one trial of the knot tying skill with no video instruction. A multiple regression analysis tested whether the amount of practice, the total practice time, or the criterion reached at the end of practice was the best predictor of the time taken to perform the skill during retention. This analysis showed that the number of practice trials was highly correlated with total practice time (r = .82, p = .01), therefore total practice time was withdrawn as a predictor variable from the subsequent analysis. The regression showed that the only significant predictor of retention performance was the criterion reached at the end of practice (p = .03). The number of practice trials was not found to significantly predict the retention performance (p = .87). The results support the notion that proficiency based training results in better retention of a technical clinical skill in comparison to duration based approaches. This provides evidence for the introduction of proficiency based educational approaches in technical skills curricula. Jowett N, LeBlanc V, Xeroulis G, MacRae H, Dubrowski A. Surgical skill acquisition with self-directed practice using computer-based video training. Am J Surg. 2007; 193(2):237-42. Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, Smith CD, Satava RM. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg. 2005; 241(2):364-72. Van Sickle KR, Ritter EM, McClusky DA, Lederman A, Baghai M, Gallagher AG, Smith CD. Attempted establishment of proficiency levels for laparoscopic performance on a national scale using simulation: the results from the 2004 SAGES Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) learning center study. Surg Endosc. 2007; 21(1):5-10.

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Psychotherapeutic components of commercially available virtual reality games (Preprint)

10.2196/preprints.21928 ◽

2020 ◽

Author(s):

Almira Osmanovic Thunström ◽

Iris Sarajlic Vuković ◽

Lilas Ali ◽

Tomas Larson ◽

Steinn Steingrimsson

Keyword(s):

Mental Health ◽

Virtual Reality ◽

Mental Health Problems ◽

Treatment Strategies ◽

Treatment Method ◽

Health Problems ◽

E Learning ◽

The Mean ◽

Unique Games

BACKGROUND Immersive virtual reality (VR) games are increasingly becoming part of everyday life. Several studies support immersive VR technology as a treatment method for mental health problems. There is however minimal research into the feasibility, prevalence, and quality of commercially available VR games on commercial platforms as tools for treatment or add on to treatment of mental health problems. OBJECTIVE The aim of this study was to explore the prevalence, feasibility and quality of commercially available games related to psychotherapy on a commercially available platform. METHODS We performed a search for keywords related to diagnosis and treatment strategies of mental health problems. The search was performed during March 27th on STEAM (VR content and gaming platform). A usability scale was used as a tool to look at the interaction and usability of the games, the VR-UI-UX-8. The tool contains 8 statements about usability scored 0-10, 0 indicating “Not at all” and 10 indicating “very much so”. The score ranges from 0-80 with a higher score indicating worse usability. RESULTS In total, 516 hits were found, 371 unique games. After the games were reviewed, 83 games passed the inclusion criteria, were purchased and played. Majority of the games which were excluded were either not connected to mental health, contained violence, adult content or were in other ways irrelevant or inappropriate. The mean score for the games on the VR-UI-UX-8 was 16.5 (standard deviation 15.8) with a range from 0-68. Most relevant and feasible games were found in the search words meditation, mindfulness, and LSD. CONCLUSIONS Commercial platforms hold great potential for VR games with psychotherapeutic components. The platforms are only at the beginning of the development towards serious games, e-learning and psychotherapeutic treatments. Currently the quality and usability for clinical and at home applicability are scarce, but hold great potential.

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Virtual reality-based relaxation for enhancement of perioperative well-being and quality of life: protocol for a randomised pilot trial

BMJ Open ◽

10.1136/bmjopen-2020-044193 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044193

Author(s):

Matthias Christian Schrempf ◽

Julian Quirin Petzold ◽

Hugo Vachon ◽

Morten Aagaard Petersen ◽

Johanna Gutschon ◽

...

Keyword(s):

Quality Of Life ◽

Virtual Reality ◽

Sample Size ◽

Stress Reduction ◽

Pilot Trial ◽

Well Being ◽

Coping Resources ◽

Patients With Cancer ◽

Sample Size Calculations

IntroductionPatients with cancer undergoing surgery often suffer from reduced quality of life and various forms of distress. Untreated distress can negatively affect coping resources as well as surgical and oncological outcomes. A virtual reality-based stress reduction intervention may increase quality of life and well-being and reduce distress in the perioperative phase for patients with cancer. This pilot trial aims to explore the feasibility of the proposed intervention, assess patient acceptability and obtain estimates of effect to provide data for sample size calculations.Methods and analysisPatients with colorectal cancer and liver metastasis undergoing elective surgery will be recruited for this single-centre, randomised pilot trial with a three-arm design. A total of 54 participants will be randomised at 1:1:1 ratio to one of two intervention groups or a control receiving standard treatment. Those randomised to an intervention group will either receive perioperative virtual reality-based stress reduction exercises twice daily or listen to classical music twice daily. Primary feasibility outcomes are number and proportions of participants recruited, screened, consented and randomised. Furthermore, adherence to the intervention, compliance with the completion of the quality of life questionnaires and feasibility of implementing the trial procedures will be assessed. Secondary clinical outcomes are measurements of the effectiveness of the interventions to inform sample size calculations.Ethics and disseminationThe study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwigs-Maximilians-University, Munich, Germany (Reference Number: 19–915). Study findings will be submitted for publication in peer-reviewed journals.Trial registration numberDRKS00020909.

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Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses

Journal of Clinical Medicine ◽

10.3390/jcm10071478 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1478

Author(s):

Alexandra Voinescu ◽

Jie Sui ◽

Danaë Stanton Fraser

Keyword(s):

Virtual Reality ◽

Cerebral Palsy ◽

Brain Injury ◽

Upper Limb ◽

Umbrella Review ◽

High Quality ◽

Quality Of Evidence ◽

Upper Limb Function ◽

Meta Analyses

Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.

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Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06846-x ◽

2021 ◽

Author(s):

Valentin Favier ◽

Tareck Ayad ◽

Fabian Blanc ◽

Nicolas Fakhry ◽

Steven Arild Wuyts Andersen

Keyword(s):

Technical Skills ◽

Surgical Technical ◽

Simulation Based

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A Novel Approach for Comparison of Reception Performance in a Technique Test and Small-Sided Games

Sports ◽

10.3390/sports9050066 ◽

2021 ◽

Vol 9 (5) ◽

pp. 66

Author(s):

Arne Sørensen ◽

Vidar Sørensen ◽

Terje Dalen

Keyword(s):

Correlation Coefficient ◽

Rank Order ◽

Technical Skills ◽

Quality Score ◽

Soccer Players ◽

Moderate Correlation ◽

Technical Aspects ◽

Youth Soccer ◽

Novel Approach

The purpose of this study was to evaluate the correlation between soccer players’ performance of receptions of passes in tests of both isolated technical skills and more match-realistic situations in small-sided games (SSGs). In addition, this study investigated whether the involvement in SSGs (number of receptions) correlated with the quality of receptions in the respective SSGs. The participants were 13 male outfield youth soccer players from teams in the first division of the regional U18 league. The quality of receptions was scored by educated coaches according to set criteria of performance. Statistical analyses of correlations were determined using Spearman’s rank-order correlation coefficient (rs). The main results were (1) a significant correlation in the quality of ball reception between 4vs1 SSGs and 5vs5 SSGs (rs = −0.61, p < 0.01) and (2) a trend towards moderate correlation between the quality of ball reception using a ball projection machine and 5vs5 SSGs (rs = −0.48, p = 0.10). (3) A significant correlation was found between the number of receptions in 5vs5 SSGs and the quality score of receptions in 5vs5 SSGs (rs = −0.70, p < 0.01). The trend towards moderate correlations between 5vs5 SSGs and the isolated technical reception test could imply the importance of training in the technical aspects of ball reception. Moreover, it seems as though the players with the best reception performance are the players who are most involved in SSGs, that is, having the most receptions.

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Rehabilitation training based on virtual reality for patients with Parkinson’s disease in improving balance, quality of life, activities of daily living, and depressive symptoms: A systematic review and meta-regression analysis

Clinical Rehabilitation ◽

10.1177/0269215521995179 ◽

2021 ◽

pp. 026921552199517

Author(s):

Runze Li ◽

Yanran Zhang ◽

Yunxia Jiang ◽

Mengyao Wang ◽

Wei How Darryl Ang ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Virtual Reality ◽

Depressive Symptoms ◽

Activities Of Daily Living ◽

Daily Living ◽

Meta Analysis ◽

Rehabilitation Training

Objective: To examine the effectiveness of rehabilitation training based on virtual reality in improving balance, quality of life, activities of daily living, and depressive symptoms of patients with Parkinson’s disease. Data sources: PubMed, EMBASE, CINAHL, Scopus, Cochrane Library, PsycINFO, ProQuest, Physiotherapy Evidence Database, IEEE Xplore, China National Knowledge Infrastructure, Wanfang, and VIP Information databases were searched from their inception to October 15, 2020. Trial registries, gray literature, and target journals were also searched. Methods: Eligible randomized controlled trials included studies with patients with Parkinson’s disease in rehabilitation training based on virtual reality. Comprehensive Meta-Analysis 3.0 software was used. Physiotherapy Evidence Database Scale and the Grading of Recommendation, Assessment, Development, and Evaluation system were used to assess the methodological quality of individual trials and the overall quality of the evidence, respectively. Results: A total of 22 randomized controlled trials with 836 patients were included. Meta-analysis revealed that training significantly improved balance ( g = 0.66, P < 0.001), quality of life ( g = 0.28, P = 0.015), activities of daily living ( g = 0.62, P < 0.001), and depressive symptoms ( g = 0.67, P = 0.021) compared to the control group. Subgroup analysis indicated that training should utilize video game consoles. Meta-regression analyses showed that age, sessions, and frequency of training had statistically significant impacts on balance scores. Quality of individual trials was high and overall evidence ranged from very low to low. Conclusion: Virtual rehabilitation training could be adopted in healthcare institutions as supplementary training for patients with Parkinson’s disease.

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