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

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.

Virtual Reality Simulator for Training on Surgery Ergonomics Skills

This work focuses on ergonomics skills based on Virtual Reality (VR) training simulator for spine surgery. The proposed system used the Head Mounted Display (HMD) device for monitoring and data collection. The aim of the project was to provide a training approach for residents that would enable them to acquire the proper ergonomic skills needed while performing spine surgery. A VR training simulator has been designed and implemented to measure two ergonomic skills required that need to be maintained during any surgery. The two components were neck’s angle and table’s height. The experiments showed that the users are usually focused on their work and tend to pay less attention to their body’s position and movements. This can result in a wrong ergonomics setup, which leads to musculoskeletal pain. Thus, the users (residents) need to be trained to have good ergonomics positions. The proposed system measured this using a specific metric that collected head positions, angles, elbow height, and other parameters. The designed model was a VR simulator for neurosurgical education in particular; however, it might be good for some other similar surgeries. The study concluded that incorporating simulations into residents’ training and simulated surgeries can strengthen the surgeons’ skills and outcomes. As a result, both residents and expert surgeons can benefit from the use of the developed model.

A VR Truck Docking Simulator Platform for Developing Personalized Driver Assistance

Professional truck drivers frequently face the challenging task of manually backwards manoeuvring articulated vehicles towards the loading bay. Logistics companies experience costs due to damage caused by vehicles performing this manoeuvre. However, driver assistance aimed to support drivers in this special scenario has not yet been clearly established. Additionally, to optimally improve the driving experience and the performance of the assisted drivers, the driver assistance must be able to continuously adapt to the needs and preferences of each driver. This paper presents the VISTA-Sim, a platform that uses a virtual reality (VR) simulator to develop and evaluate personalized driver assistance. This paper provides a comprehensive account of the VISTA-Sim, describing its development and main functionalities. The paper reports the usage of VISTA-Sim through the scenario of parking a semi-trailer truck in a loading bay, demonstrating how to learn from driver behaviours. Promising preliminary results indicate that this platform provides means to automatically learn from a driver’s performance. The evolution of this platform can offer ideal conditions for the development of ADAS systems that can automatically and continuously learn from and adapt to an individual driver. Therefore, future ADAS systems can be better accepted and trusted by drivers. Finally, this paper discusses the future directions concerning the improvement of the platform.

Improvement of three-dimensional motion sickness using a virtual reality simulator for robot-assisted surgery in undergraduate medical students: A prospective observational study

Background A virtual reality (VR) simulator is utilized as an inexpensive tool for gaining basic technical competence in robotic-assisted surgery (RAS). We evaluated operator 3D motion sickness while using a VR simulator and assessed whether it can be reduced by repeating the training. Methods This prospective observational study was conducted at the Department of Urology, Iwate Medical University, a tertiary training hospital in an urban setting. A total of 30 undergraduate medical students participated in the study. We compared whether the VR simulator improved the students’ skills in operating the da Vinci robot. Fifteen students underwent training with a VR simulator for 4 h a day for 5 days. Then, motion sickness was determined using the Visual Analog Scale and Simulator Sickness Questionnaire (SSQ) before and after the training. Results Manipulation time significantly improved after training compared to before training (293.9 ± 72.4 versus 143.6 ± 18.4 s; p < 0.001). Although motion sickness worsened after each training session, it gradually improved with continuous practice with the VR simulator. SSQ subscores showed that the VR simulator induced nausea, disorientation, and oculomotor strain, and oculomotor strain was significantly improved with repeated training. Conclusions In undergraduate students, practice with the VR simulator improved RAS skills and operator 3D motion sickness caused by 3D manipulation of the da Vinci robot.

Development and Evaluation of a Virtual Environment to Assess Cycling Hazard Perception Skills

Safe cycling requires situational awareness to identify and perceive hazards in the environment to react to and avoid dangerous situations. Concurrently, tending to external distractions leads to a failure to identify hazards or to respond appropriately in a time-constrained manner. Hazard perception training can enhance the ability to identify and react to potential dangers while cycling. Although cycling on the road in the presence of driving cars provides an excellent opportunity to develop and evaluate hazard perception skills, there are obvious ethical and practical risks, requiring extensive resources to facilitate safety, particularly when involving children. Therefore, we developed a Cycling and Hazard Perception virtual reality (VR) simulator (CHP-VR simulator) to create a safe environment where hazard perception can be evaluated and/or trained in a real-time setting. The player interacts in the virtual environment through a stationary bike, where sensors on the bike transfer the player’s position and actions (speed and road positioning) into the virtual environment. A VR headset provides a real-world experience for the player, and a procedural content generation (PCG) algorithm enables the generation of playable artifacts. Pilot data using experienced adult cyclists was collected to develop and evaluate the VR simulator through measuring gaze behavior, both in VR and in situ. A comparable scene (cycling past a parked bus) in VR and in situ was used. In this scenario, cyclists fixated 20% longer at the bus in VR compared to in situ. However, limited agreement identified that the mean differences fell within 95% confidence intervals. The observed differences were likely attributed to a lower number of concurrently appearing elements (i.e., cars) in the VR environment compared with in situ. Future work will explore feasibility testing in young children by increasing assets and incorporating a game scoring system to direct attention to overt and covert hazards.

Objective Measurement of Impact of Bench Laparoscopic Training in Novices

Background: We are currently in the era of laparoscopic surgery. It has gained popularity in the last few decades because of its well- known advantages. Laparoscopy requires different skills from those of open surgery. In a paradigm shift, learning basic surgical skills is now performed more in the skills laboratory than in the operation theater. However, there is a lack of reliable training and assessment tools for laparoscopic surgical skills. This study aimed to objectively assess the effect of bench laparoscopic training in novices. Methods: This prospective study was conducted at the Clinical Skills Centre of Bangalore Medical College and Research Institute (BMCRI) in Bangalore, India. Sixty interns with no previous experience in laparoscopy were included. They underwent supervised training on the box trainer for 3 days, 2 hours a day, in basic surgical tasks, including pointing dots, joining straight lines, joining curved lines, picking objects, peg transfer, and circle cut. All participants were assessed objectively in a virtual reality (VR) simulator before and after training. The objective outcomes measured were time taken, distance traveled, and error scores given by the VR simulator metrics. Results: The novices showed statistically significant improvement in all the tasks after the training compared with their skill levels before the training. Conclusion: Structured short-term training significantly improves basic laparoscopic surgery skills.

The impact of virtual reality training on laparoscopic surgical skills; A prospective blinded controlled trial

Background. Laparoscopic surgery has gained popularity in the last few decades replacing open standard techniques in several procedures. While its use and scope expand, a standardized method of training and assessment in laparoscopic skills is lacking. Aim. To assess the effect of virtual reality (VR) training on laparoscopic surgical skills. Materials and Methods. It is a prospective, controlled study conducted at Sagar Hospital’s skill lab and Shanthi Hospital and Research Centre (SHRC). We included 27 post graduates in general surgery. They were divided into two groups. One group underwent training in VR Simulator for one week, 30 minutes each day. The second group received no training. Their proficiency while mobilizing the Gallbladder from its liver bed was assessed using a validated scale by a single blinded observer. Results. The statistical analysis was done using a non-parametric test (Mann-Whitney U test). Residents who underwent training in VR simulator got better scores in Overall rating and also in individual parameters when compared with the control group (P = <0.05). Conclusions. Laparoscopic surgical skills can be increased by using proficiency-based VR simulator training and it can be transferred to actual operations. VR simulators are a valid tool for laparoscopic surgical skills training.