Validation of a novel virtual reality simulation system with the focus on training for surgical dissection during laparoscopic sigmoid colectomy

Abstract Background Mastery of technical skills is one of the fundamental goals of surgical training for novices. Meanwhile, performing laparoscopic procedures requires exceptional surgical skills compared to open surgery. However, it is often difficult for trainees to learn through observation and practice only. Virtual reality (VR)-based surgical simulation is expanding and rapidly advancing. A major obstacle for laparoscopic trainees is the difficulty of well-performed dissection. Therefore, we developed a new VR simulation system, Lap-PASS LP-100, which focuses on training to create proper tension on the tissue in laparoscopic sigmoid colectomy dissection. This study aimed to validate this new VR simulation system. Methods A total of 50 participants were asked to perform medial dissection of the meso-sigmoid colon on the VR simulator. Forty-four surgeons and six non-medical professionals working in the National Cancer Center Hospital East, Japan, were enrolled in this study. The surgeons were: laparoscopic surgery experts with > 100 laparoscopic surgeries (LS), 21 were novices with experience < 100 LS, and five without previous experience in LS. The participants’ surgical performance was evaluated by three blinded raters using Global Operative Assessment of Laparoscopic Skills (GOALS). Results There were significant differences (P-values < 0.044) in all GOALS items between the non-medical professionals and surgeons. The experts were significantly superior to the novices in one item of GOALS: efficiency ([4(4–5) vs. 4(3–4)], with a 95% confidence interval, p = 0.042). However, both bimanual dexterity and total score in the experts were not statistically different but tended to be higher than in the novices. Conclusions Our study demonstrated a full validation of our new system. This could detect the surgeons' ability to perform surgical dissection and suggest that this VR simulator could be an effective training tool. This surgical VR simulator might have tremendous potential to enhance training for surgeons.

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Hybrid Surgical Simulator: A Temporal Bone Simulator Validation Study of the Stryker Surgical Simulator (S3)

Military Medicine ◽

10.1093/milmed/usaa178 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2026-e2031

Author(s):

Charles Meyer ◽

Francine Noda ◽

Craig R Folsom

Keyword(s):

Temporal Bone ◽

Content Validity ◽

Haptic Feedback ◽

Surgical Simulation ◽

Subjective Evaluation ◽

Face Validity ◽

Task Completion ◽

Surgical Simulator ◽

Surgical Performance ◽

Training Tool

ABSTRACT Introduction The Stryker Surgical Simulator is a hybrid, temporal bone simulator that uses both tactile and haptic feedback combined with a computer interface. We sought to validate this simulator as an otolaryngology resident training tool for performing tympanomastoidectomy. Materials and Methods 15 residents and staff performed five basic cortical mastoidectomies. Staff surgeons comprised the “expert” cohort and resident surgeons comprised the “trainee” cohort. Subjective evaluation of the face validity and content validity was assessed via pre- and postquestionnaires. Objective evaluation of content validity was assessed through grading of each temporal bone dissection specimen, comparing time to task completion, and calculating the rate of injury to critical structures. Study approved by the Institutional Review Board (2013.0001). Results Post hoc questionnaires showed that both staff and residents subjectively rated the simulator favorably on face validity, content validity, and all global assessment categories, though there were no significant distinctions between groups (P > 0.05). The resident group had a significantly longer drilling time compared with the staff group throughout the series of tympanomastoidectomies (P = 0.008), and both groups showed a decrease in time to task completion with repetitive drilling. However, there were no significant differences in surgical performance as evaluated by a blinded senior neurotologist (P = 0.52). There were also no critical injuries recorded by the simulator in any of the 75 trials, preventing any evaluation on this measure. Conclusions Despite favorable subjective evaluations by both staff and residents, objective discrimination between experienced and novice participants was not achieved. This was likely in part due to inherent design flaws of the simulator. This emphasizes the potential shortcomings of surgical simulation models for highly technical procedures and points to the importance of intensive study and validation prior to incorporation of commercial training models into surgical training programs.

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A Virtual Reality-based Surgical Simulation System for Virtual Neuroendoscopy

2007 IEEE International Conference on Integration Technology ◽

10.1109/icitechnology.2007.4290473 ◽

2007 ◽

Cited By ~ 5

Author(s):

Chu-Yu Tang ◽

Wai Chin ◽

Yim-Pan Chui ◽

Wai-Sang Poon ◽

Pheng-Ann Heng

Keyword(s):

Virtual Reality ◽

Surgical Simulation ◽

Simulation System

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Peak and ceiling effects in final-product analysis of mastoidectomy performance

The Journal of Laryngology & Otology ◽

10.1017/s0022215115002364 ◽

2015 ◽

Vol 129 (11) ◽

pp. 1091-1096 ◽

Cited By ~ 6

Author(s):

N West ◽

L Konge ◽

P Cayé-Thomasen ◽

M S Sørensen ◽

S A W Andersen

Keyword(s):

Virtual Reality ◽

Surgical Simulation ◽

Ceiling Effect ◽

Virtual Reality Simulator ◽

Single Session ◽

Product Analysis ◽

Maximum Score ◽

Training Tool ◽

Ceiling Effects ◽

Better Than

AbstractBackground:Virtual reality surgical simulation of mastoidectomy is a promising training tool for novices. Final-product analysis for assessing novice mastoidectomy performance could be limited by a peak or ceiling effect. These may be countered by simulator-integrated tutoring.Methods:Twenty-two participants completed a single session of self-directed practice of the mastoidectomy procedure in a virtual reality simulator. Participants were randomised for additional simulator-integrated tutoring. Performances were assessed at 10-minute intervals using final-product analysis.Results:In all, 45.5 per cent of participants peaked before the 60-minute time limit. None of the participants achieved the maximum score, suggesting a ceiling effect. The tutored group performed better than the non-tutored group but tutoring did not eliminate the peak or ceiling effects.Conclusion:Timing and adequate instruction is important when using final-product analysis to assess novice mastoidectomy performance. Improved real-time feedback and tutoring could address the limitations of final product based assessment.

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1393 The Impact of Using A Virtual Reality Surgical Curriculum to Train Scrub Practitioners in Complex Orthopaedic Surgery

British Journal of Surgery ◽

10.1093/bjs/znab259.837 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T C Edwards ◽

A Patel ◽

B Szyszka ◽

A W Coombs ◽

R Kucheria ◽

...

Keyword(s):

Virtual Reality ◽

Orthopaedic Surgery ◽

Training Session ◽

Revision Total Knee Arthroplasty ◽

Dominant Hand ◽

Surgical Performance ◽

Training Tool ◽

Duration Of Surgery ◽

Effective Transfer ◽

The Impact

Abstract Background The training scrub practitioners receive varies considerably in comparison to their surgical counterpart, although their performance is key to a proficient surgical team. For infrequent procedures that require specific and often intricate equipment such as revision total knee arthroplasty (RTKA), their training may be limited to an initial guidance session by company representatives. This study aims to evaluate the impact of using a virtual reality (VR) curriculum to train scrub practitioners in the performance of a RTKA. Method Ten orthopaedic scrub practitioners were enrolled into VR training across four sessions. Each VR session consisted of training where participants were guided through the assembly of equipment and steps of the surgery. In the concluding three sessions, each training session was supplemented by an assessment session in VR without guidance. The outcomes measured in VR assessment were incorrect procedural sequence, duration of surgery and efficiency of movement. The transfer of skills outside VR were assessed pre-training and post-training by the participants performance in a sequence of tasks using real equipment. Results All participants enhanced their surgical performance in successive assessed VR sessions reducing their operative time by 47%, assistive prompts by 75% and dominant hand motion by 28%. Improvements in VR showed effective transfer when assessed using real equipment with participants achieving superior scores post-training (11.3% versus 83.5%). Conclusions VR enables safe learning and provides measurable feedback of procedural steps and technical skills of complex orthopaedic surgery. VR is an effective training tool for scrub practitioners, with transfer to the real world.

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A Physics-Driven Neural Networks-Based Simulation System (PhyNNeSS) for Multimodal Interactive Virtual Environments Involving Nonlinear Deformable Objects

Presence Teleoperators & Virtual Environments ◽

10.1162/pres_a_00054 ◽

2011 ◽

Vol 20 (4) ◽

pp. 289-308 ◽

Cited By ~ 12

Author(s):

Suvranu De ◽

Dhannanjay Deo ◽

Ganesh Sankaranarayanan ◽

Venkata S. Arikatla

Keyword(s):

Neural Networks ◽

Real Time ◽

Surgical Simulation ◽

Radial Basis Function Network ◽

Simulation System ◽

Nonlinear Material ◽

Deformable Objects ◽

Interactive Simulation ◽

Training Tool ◽

Update Rate

While an update rate of 30 Hz is considered adequate for real-time graphics, a much higher update rate of about 1 kHz is necessary for haptics. Physics-based modeling of deformable objects, especially when large nonlinear deformations and complex nonlinear material properties are involved, at these very high rates is one of the most challenging tasks in the development of real-time simulation systems. While some specialized solutions exist, there is no general solution for arbitrary nonlinearities. In this work we present PhyNNeSS—a Physics-driven Neural Networks-based Simulation System—to address this long-standing technical challenge. The first step is an offline precomputation step in which a database is generated by applying carefully prescribed displacements to each node of the finite element models of the deformable objects. In the next step, the data is condensed into a set of coefficients describing neurons of a Radial Basis Function Network (RBFN). During real-time computation, these neural networks are used to reconstruct the deformation fields as well as the interaction forces. We present realistic simulation examples from interactive surgical simulation with real-time force feedback. As an example, we have developed a deformable human stomach model and a Penrose drain model used in the Fundamentals of Laparoscopic Surgery (FLS) training tool box. A unique computational modeling system has been developed that is capable of simulating the response of nonlinear deformable objects in real time. The method distinguishes itself from previous efforts in that a systematic physics-based precomputational step allows training of neural networks which may be used in real-time simulations. We show, through careful error analysis, that the scheme is scalable, with the accuracy being controlled by the number of neurons used in the simulation. PhyNNeSS has been integrated into SoFMIS (Software Framework for Multimodal Interactive Simulation) for general use.

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Virtual reality simulation in robot-assisted surgery: meta-analysis of skill transfer and predictability of skill

BJS Open ◽

10.1093/bjsopen/zraa066 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

M W Schmidt ◽

K F Köppinger ◽

C Fan ◽

K -F Kowalewski ◽

L P Schmidt ◽

...

Keyword(s):

Virtual Reality ◽

Quantitative Analysis ◽

Operating Room ◽

Meta Analysis ◽

Surgical Skills ◽

Cochrane Central Register ◽

Robot Assisted ◽

Surgical Performance ◽

Robot Assisted Surgery ◽

Vr Simulator

Abstract Background The value of virtual reality (VR) simulators for robot-assisted surgery (RAS) for skill assessment and training of surgeons has not been established. This systematic review and meta-analysis aimed to identify evidence on transferability of surgical skills acquired on robotic VR simulators to the operating room and the predictive value of robotic VR simulator performance for intraoperative performance. Methods MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science were searched systematically. Risk of bias was assessed using the Medical Education Research Study Quality Instrument and the Newcastle–Ottawa Scale for Education. Correlation coefficients were chosen as effect measure and pooled using the inverse-variance weighting approach. A random-effects model was applied to estimate the summary effect. Results A total of 14 131 potential articles were identified; there were eight studies eligible for qualitative and three for quantitative analysis. Three of four studies demonstrated transfer of surgical skills from robotic VR simulators to the operating room measured by time and technical surgical performance. Two of three studies found significant positive correlations between robotic VR simulator performance and intraoperative technical surgical performance; quantitative analysis revealed a positive combined correlation (r = 0.67, 95 per cent c.i. 0.22 to 0.88). Conclusion Technical surgical skills acquired through robotic VR simulator training can be transferred to the operating room, and operating room performance seems to be predictable by robotic VR simulator performance. VR training can therefore be justified before operating on patients.

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