Validity and reliability evidence support task-specific metrics for laparoscopic fundoplication

BACKGROUND

Laparoscopic hiatal hernia repair (LHHR) is a complex operation requiring advanced surgical training. Surgical simulation offers a potential solution for learning complex operations without the need for high surgical volume. Our goal is to develop a virtual reality (VR) simulator for LHHR; however, data supporting task-specific metrics for this procedure are lacking. The purpose of this study was to develop and assess validity and reliability evidence of task-specific metrics for the fundoplication phase of LHHR.

METHODS

In phase I, structured interviews with expert foregut surgeons were conducted to develop task-specific metrics (TSM). In phase II, participants with varying levels of surgical expertise performed a laparoscopic Nissen fundoplication procedure on a porcine stomach explant. Video recordings were independently assessed by two blinded graders using global and TSM. An intraclass correlation coefficient (ICC) was used to assess interrater reliability (IRR). Performance scores were compared using a Kruskal-Wallis test. Spearman's rank correlation was used to evaluate the association between global and TSM.

RESULTS

Phase I of the study consisted of 12 interviews with expert foregut surgeons. Phase II engaged 31 surgery residents, a fellow, and 6 attendings in the simulation. Phase II results showed high IRR for both global (ICC = 0.84, p < 0.001) and TSM (ICC = 0.75, p < 0.001). Significant between-group differences were detected for both global (χ2 = 24.01, p < 0.001) and TSM (χ2 = 18.4, p < 0.001). Post hoc analysis showed significant differences in performance between the three groups for both metrics (p < 0.05). There was a strong positive correlation between the global and TSM (rs = 0.86, p < 0.001).

CONCLUSION

We developed task-specific metrics for LHHR and using a fundoplication model, we documented significant reliability and validity evidence. We anticipate that these LHHR task-specific metrics will be useful in our planned VR simulator.

An objective evaluation of simulated surgical outcomes among surgical trainees using manual small-incision cataract surgery virtual reality simulator

Purpose

The purpose of this study was to evaluate trainee performance across six modules of a virtual reality (VR) simulator.

Methods

A retrospective observational study was conducted on 10 manual small-incision cataract surgery (MSICS) trainees who practiced cataract surgery on an MSICS VR simulator for one month. They were assessed in six major steps which included scleral groove, tunnel dissection, keratome entry, capsulorhexis, nucleus delivery, and intraocular lens (IOL) insertion under a trainer's supervision. The information included in their score metrics was collected, and their overall performance was evaluated.

Results

Thirty attempts were evaluated for scleral groove, tunnel dissection, and capsulorhexis and 15 attempts for keratome entry. Candidates had varied results in the dimensional aspects and their rates of complications with a mean satisfactory score of 3.1 ± 4.17, 6.8 ± 5.75, 5.8 ± 7.74, and 1.8 ± 2.57, respectively. Nucleus delivery (n = 5) had more of iris pull and IOL insertion (n = 5) had more of lost IOL as complications but both had a higher satisfactory outcome.

Conclusion

A VR simulator is a useful tool for training surgeons before their entry into live surgery. It is an effective method for evaluating objectively the structural characteristics of each phase in MSICS and their associated complications, helping them anticipate it earlier during live surgery by giving them a near real world experience.

Virtual fieldwork on a ship's bridge: virtual reality-reconstructed operation scenarios as contextual substitutes for fieldwork in design education

Designing for professional, high-risk user contexts often implies limited accessibility for interaction designers to conduct field research and field testing, and the measures taken by most universities in Norway in 2020 to prevent COVID-19 spread have further contributed to the problem of achieving the contextual insight needed throughout the design process by severely restricting travel for research purposes. In this paper, we describe the use of virtual reality-reconstructed operation scenarios (VRROS) for Arctic-going vessels implemented in support of and as a substitute for the contextual aspects of fieldwork in the education of master's students studying interaction design. The virtual reality rig contains three scenarios contextualizing ships' bridges and their surroundings originally developed for research on designing navigation and operation applications using augmented reality technology. We evaluate whether aspects of the VRROS can substitute for real fieldwork by evaluating students' use of the VRROS using a student questionnaire. Finally, we discuss the value and potential of using VRROS as a supplement and support when studying how to design for hard-to-reach contexts in the future.

Learning procedural skills with a virtual reality simulator: An acceptability study

BACKGROUND

Virtual Reality (VR) simulation has recently been developed and has improved surgical training. Most VR simulators focus on learning technical skills and few on procedural skills. Studies that evaluated VR simulators focused on feasibility, reliability or easiness of use, but few of them used a specific acceptability measurement tool.

OBJECTIVES

The aim of the study was to assess acceptability and usability of a new VR simulator for procedural skill training among scrub nurses, based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model.

PARTICIPANTS

The simulator training system was tested with a convenience sample of 16 non-expert users and 13 expert scrub nurses from the neurosurgery department of a French University Hospital.

METHODS

The scenario was designed to train scrub nurses in the preparation of the instrumentation table for a craniotomy in the operating room (OR).

RESULTS

Acceptability of the VR simulator was demonstrated with no significant difference between expert scrub nurses and non-experts. There was no effect of age, gender or expertise. Workload, immersion and simulator sickness were also rated equally by all participants. Most participants stressed its pedagogical interest, fun and realism, but some of them also regretted its lack of visual comfort.

CONCLUSION

This VR simulator designed to teach surgical procedures can be widely used as a tool in initial or vocational training.

[Evaluation of a virtual reality simulator for learning direct ophthalmoscopy in student teaching]

BACKGROUND

The use of direct ophthalmoscopy in non-ophthalmological specialties seems to be decreasing in the clinical routine. This could be due to a lack of training and thus an uncertain assessment.

OBJECTIVE

The aim of this study was to evaluate the effectiveness and acceptance of learning direct ophthalmoscopy on a simulator in comparison to the classical teaching method among students.

MATERIAL AND METHODS

Within the framework of the student block internship for ophthalmology, a total of 34 students took part in the project. The first group received classical training, the second group received simulator training. The learning success was assessed by an objective structured clinical examination (OSCE).

RESULTS

The simulator training group showed a significantly higher points score in individual disciplines. The subjects in the classical group achieved a learning success in the OSCE of 78%. In the simulator-based group a higher score of 91% was achieved with a lower scatter in all subdisciplines.

DISCUSSION

The patient and instructor-independent availability of the teaching materials, a reduction of light exposure for patients and test subjects, as well as a standardized and controlled mediation of physiological and pathological findings can be emphasized as advantages of the tested simulator.

CONCLUSION

The simulator-based training for learning direct funduscopy is effective. The virtual reality simulator evaluated in this project can improve the training of students and residents.

VCSim3: a VR simulator for cardiovascular interventions

PURPOSE

Effective and safe performance of cardiovascular interventions requires excellent catheter/guidewire manipulation skills. These skills are currently mainly gained through an apprenticeship on real patients, which may not be safe or cost-effective. Computer simulation offers an alternative for core skills training. However, replicating the physical behaviour of real instruments navigated through blood vessels is a challenging task.

METHODS

We have developed VCSim3-a virtual reality simulator for cardiovascular interventions. The simulator leverages an inextensible Cosserat rod to model virtual catheters and guidewires. Their mechanical properties were optimized with respect to their real counterparts scanned in a silicone phantom using X-ray CT imaging. The instruments are manipulated via a VSP haptic device. Supporting solutions such as fluoroscopic visualization, contrast flow propagation, cardiac motion, balloon inflation, and stent deployment, enable performing a complete angioplasty procedure.

RESULTS

We present detailed results of simulation accuracy of the virtual instruments, along with their computational performance. In addition, the results of a preliminary face and content validation study conveyed on a group of 17 interventional radiologists are given.

CONCLUSIONS

VR simulation of cardiovascular procedure can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. VCSim3 is still a prototype, yet the initial results indicate that it provides promising foundations for further development.

Objective assessment of skills acquisition during laparoscopic surgery courses

BACKGROUND

The aim of this prospective study is to objectively assess the acquisition of skills of trainees attending laparoscopic surgery courses.

METHODS

Thirty-four junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate runs of 3-day core skills in laparoscopic surgery course. Nine control trainees were also included who did not attend the course. Three virtual tasks (camera navigation, hand-eye coordination, and 2-handed maneuver) were used from a virtual reality simulator (Simbionix) for assessment. Camera navigation was assessed by completion time and maintenance of horizontal view, whereas the other 2 tasks were assessed by completion time, path length (both hands), and the number of movements (both hands). A composite score of overall performance was calculated by combining all the 12 parameters.

RESULTS

The course significantly (P < 0.001) improved 91% of the junior trainees' precourse laparoscopic skills. Around 70% to 85% of the participants had improvement in skills in all the parameters following the course. The significant improvements were seen in 10 out of 12 task-specific parameters (P ≤ .004) except path length of the left hand. No significant improvement in skills was seen in any 1 of the 12 parameters for the control participants except for a slight reduction in performance matrics. Foundation and core trainees had acquired significantly (P = .02) more skills (23% improvement) than the specialist trainees (8% improvement). Overall acquired skills did not differ significantly in terms of age, sex, or dominant hand of trainees.

CONCLUSION

Objective validated methods can be used to demonstrate course efficacy in addition to providing participants with an insight into their skills. Junior trainees with little or no previous experience benefit the most from such courses irrespective of their age, sex, and dominant hand.