Learning curves of basic laparoscopic psychomotor skills in SINERGIA VR simulator

Virtual Reality in Medical Students' Education: Scoping Review

BACKGROUND

Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education.

OBJECTIVE

The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research.

METHODS

We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

RESULTS

Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR.

CONCLUSIONS

Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-046986.

The evolution of surgical virtual education and telementoring: One surgeon's journey

The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation.

Comparative Study of the Use of Different Sizes of an Ergonomic Instrument Handle for Laparoscopic Surgery

Previous studies have shown that the handle design of laparoscopic instruments is crucial to surgical performance and surgeon’s ergonomics. In this study, four different sizes of an ergonomic laparoscopic handle design were tested in a blind and randomized fashion with twelve surgeons. They performed three laparoscopic tasks in order to analyze the influence of handle size. Execution time, wrist posture, and finger and palm pressure were evaluated during the performance of each task. The results show a significant reduction in the time required to complete the eye-manual coordination task using the appropriate handle. The incorrectly sized handle resulted in a rise in palm pressure and a reduction in the force exerted by the thumb during the transfer task. In the hand-eye coordination task, the use of the right handle size led to an increase in middle finger pressure. In general, surgeons had an ergonomically adequate wrist flexion in all tasks and an acceptable radio-ulnar deviation during the transfer task using the ergonomic instrument handle. Surgeons found it comfortable the use of the ergonomic handle. Therefore, the use of an appropriately sized instrument handle allows surgeons to improve ergonomics and surgical performance during the laparoscopic practice.

[Objective surgery -- advanced robotic devices and simulators used for surgical skill assessment]

Robotic assistance became a leading trend in minimally invasive surgery, which is based on the global success of laparoscopic surgery. Manual laparoscopy requires advanced skills and capabilities, which is acquired through tedious learning procedure, while da Vinci type surgical systems offer intuitive control and advanced ergonomics. Nevertheless, in either case, the key issue is to be able to assess objectively the surgeons' skills and capabilities. Robotic devices offer radically new way to collect data during surgical procedures, opening the space for new ways of skill parameterization. This may be revolutionary in MIS training, given the new and objective surgical curriculum and examination methods. The article reviews currently developed skill assessment techniques for robotic surgery and simulators, thoroughly inspecting their validation procedure and utility. In the coming years, these methods will become the mainstream of Western surgical education.

Development and evaluation of a canine laparoscopic simulator for veterinary clinical training

Human laparoscopic simulators have been used in medical education for minimally invasive surgery (MIS) in the past years. Simulator-based laparoscopic training has attracted much interest because unique skills have to be learned not only by surgeons in training but also by surgeons in practice. MIS forces the surgeon to adapt to monocular vision and decreased tactile sensation and entails training and improving hand-eye and hand-hand coordination. Those skills require a learning curve that could be overcome gradually with use of simulators. The Canine Laparoscopic Simulator (CLS) for laparoscopic training was developed based on the working and optical space obtained from computed tomography (CT) scan images of three Beagle dogs. Thirty veterinarians (expert group, n=7; novice group, n=23) performed basic laparoscopic exercises in one training session on the CLS. During the performance of the exercises, an experienced laparoscopic veterinarian assessed all the tasks. Afterwards, participants were asked to complete an anonymous survey describing their experience. Most participants expressed positive opinions about the design and usability of the CLS. There were no significant differences between the two groups' opinions. The CLS showed good preliminary acceptance in the basic laparoscopy tasks by veterinarians. They perceived it to be a good training tool, and these results suggest that CLS is an engaging tool for education but still has some limitations inherent in training boxes. Further studies would be needed to establish the validity of training programs performed in the CLS.