User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting

PURPOSE Limited access to adequate cancer surgery training is one of the driving forces behind global inequities in surgical cancer care. Affordable virtual reality (VR) surgical training could enhance surgical skills in low- and middle-income settings, but most VR and augmented reality systems are too expensive and do not teach open surgical techniques commonly practiced in these contexts. New low-cost VR can offer skill development simulations relevant to these settings, but little is known about how knowledge is gained and applied by surgeons training and working in specific resource-constrained settings. This study addresses this gap, exploring gynecologic oncology trainee learning and user experience using a low-cost VR simulator to learn to perform an open radical abdominal hysterectomy in Lusaka, Zambia. METHODS Eleven surgical trainees rotating through the gynecologic oncology service were sequentially recruited from the University Teaching Hospital in Lusaka to participate in a study evaluating a VR radical abdominal hysterectomy training designed to replicate the experience in a Zambian hospital. Six participated in semi-structured interviews following the training. Interviews were analyzed using open and axial coding, informed by grounded theory. RESULTS Simulator participation increased participants' perception of their surgical knowledge, confidence, and skills. Participants believed their skills transferred to other related surgical procedures. Having clear goals and motivation to improve were described as factors that influenced success. CONCLUSION For cancer surgery trainees in lower-resourced settings learning medical and surgical skills, even for those with limited VR experience, low-cost VR simulators may enhance anatomical knowledge and confidence. The VR simulator reinforced anatomical and clinical knowledge acquired through other modalities. VR-enhanced learning may be particularly valuable when mentored learning opportunities are limited.

Anesthetic Considerations in Patients with Automatic Implantable Cardio Defibrillator Presenting for Noncardiac Surgery

Patients with automatic implantable cardioverter defibrillators commonly present for noncardiac surgery. It is imperative that anesthesiologists be aware of perioperative considerations in such patients. Preoperative evaluation includes determining indication for placement, date of last interrogation, pacemaker dependency, battery longevity, and magnet responses. Site of surgery and use of devices that generate EMI are also important for determining appropriate management strategy for such devices. If a cardiac implantable electronic device (CIED) team is available, it should be consulted for a perioperative plan. In this chapter a case study of a 60-year-old woman presenting for open radical abdominal hysterectomy in view of recently diagnosed endometrial cancer is used as an example.