Virtual Reality – A New Era in Surgical Training

The introduction of virtual reality and simulation into the world of surgery came about for a number of reasons. The most paramount reason being the adoption of laparoscopy which was first introduced in the 1990s. The advent of laparoscopy and minimally invasive procedures has created a necessity for more novel techniques to learn surgical skills. The skill set required in laparoscopy is very different compared with open conventional surgery(1). This is due to lack of tactile feedback, precise hand eye coordination, and a change from 3D to 2D visualisation as well as adaption to the fulcrum effect(2, 3). This skill set cannot be taught easily in the real life environment under the supervision of a senior surgeon. With the traditional open approach the supervising surgeon can directly guide the hands of the trainee and immediately intervene if a problem or difficulty arises. In laparoscopy however the expert surgeon has less control over what the trainee is doing. If a complication were to arise during the course of the surgery it would be more difficult for the expert surgeon to intervene and rectify the situation. The same can be said for endovascular procedures and endoscopy. The learning curve is also steeper in minimally invasive procedures than for open surgery as trainees have to learn not only new technology and overcome obstacles like the fulcrum effect but they also have to have a good fundamental ability for these procedures as well.

[1]  Christopher W. Snyder,et al.  Effects of Virtual Reality Simulator Training Method and Observational Learning on Surgical Performance , 2011, World Journal of Surgery.

[2]  T. Grantcharov,et al.  Learning curves and impact of psychomotor training on performance in simulated colonoscopy: a randomized trial using a virtual reality endoscopy trainer , 2004, Surgical Endoscopy And Other Interventional Techniques.

[3]  Michitaka Fujiwara,et al.  Construct validity of the LapVR virtual-reality surgical simulator , 2011, Surgical Endoscopy.

[4]  G. Wiggins,et al.  Understanding by Design , 1998 .

[5]  Melina C Vassiliou,et al.  A global assessment tool for evaluation of intraoperative laparoscopic skills. , 2005, American journal of surgery.

[6]  R. Reznick,et al.  Validation of an objective structured assessment of technical skill for surgical residents , 1996, Academic medicine : journal of the Association of American Medical Colleges.

[7]  Rajesh Aggarwal,et al.  Deliberate Practice on a Virtual Reality Laparoscopic Simulator Enhances the Quality of Surgical Technical Skills , 2011, Annals of surgery.

[8]  Anthony G Gallagher,et al.  Optimising surgical training: use of feedback to reduce errors during a simulated surgical procedure , 2011, Postgraduate Medical Journal.

[9]  Anthony G Gallagher,et al.  Role and feasibility of psychomotor and dexterity testing in selection for surgical training , 2009, ANZ journal of surgery.

[10]  Charles Vincent,et al.  Technical and Technological Skills Assessment in Laparoscopic Surgery , 2006, JSLS : Journal of the Society of Laparoendoscopic Surgeons.

[11]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[12]  M R Moran,et al.  The learning curve for laparoscopic colorectal surgery. , 1997, Archives of surgery.

[13]  G. Fried,et al.  GOALS-Incisional Hernia: A Valid Assessment of Simulated Laparoscopic Incisional Hernia Repair , 2011, Surgical innovation.

[14]  B Cagir,et al.  The learning curve for laparoscopic cholecystectomy. , 1994, Journal of laparoendoscopic surgery.

[15]  Lloyd L. Kelly,et al.  The Pilot Maker , 1970 .

[16]  A. Shabbir,et al.  Laparoscopic appendectomy by residents: evaluating outcomes and learning curve , 2009, Surgical Endoscopy.

[17]  M. Pellen,et al.  Construct validity of the ProMIS laparoscopic simulator , 2008, Surgical Endoscopy.

[18]  K. Conlon,et al.  Construct validation of a novel hybrid surgical simulator , 2006, Surgical Endoscopy And Other Interventional Techniques.

[19]  R. Satava,et al.  Virtual Reality Simulation for the Operating Room: Proficiency-Based Training as a Paradigm Shift in Surgical Skills Training , 2005, Annals of surgery.

[20]  Anthony G. Gallagher,et al.  Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons , 2008, Surgical Endoscopy.

[21]  K. A. Ericsson,et al.  Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. , 2004, Academic medicine : journal of the Association of American Medical Colleges.

[22]  E. Verdaasdonk,et al.  Objective assessment of technical surgical skills , 2010, The British journal of surgery.

[23]  Teodor P Grantcharov,et al.  Teaching procedural skills , 2008, BMJ : British Medical Journal.

[24]  Teodor P Grantcharov,et al.  Can everyone achieve proficiency with the laparoscopic technique? Learning curve patterns in technical skills acquisition. , 2009, American journal of surgery.

[25]  J. J. Jakimowicz,et al.  Suturing training in Augmented Reality: gaining proficiency in suturing skills faster , 2008, Surgical Endoscopy.

[26]  J. Dungan,et al.  Effect of virtual reality training on laparoscopic surgery: randomised controlled trial , 2010 .

[27]  D I Watson,et al.  A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? , 1996, Annals of surgery.

[28]  R. Satava,et al.  Virtual reality as a metric for the assessment of laparoscopic psychomotor skills , 2002, Surgical Endoscopy And Other Interventional Techniques.

[29]  D. Scott,et al.  The impact of intense laparoscopic skills training on the operative performance of urology residents. , 2001, The Journal of urology.

[30]  A. Darzi,et al.  Development of a virtual reality training curriculum for laparoscopic cholecystectomy , 2009, The British journal of surgery.

[31]  Rajesh Aggarwal,et al.  An Evidence-Based Virtual Reality Training Program for Novice Laparoscopic Surgeons , 2006, Annals of surgery.

[32]  S. Stryker,et al.  The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. , 1997, Archives of surgery.

[33]  J. Dankelman,et al.  Transfer validity of laparoscopic knot-tying training on a VR simulator to a realistic environment: A randomized controlled trial , 2008, Surgical Endoscopy.

[34]  T. Grantcharov,et al.  Randomized clinical trial of virtual reality simulation for laparoscopic skills training , 2004, The British journal of surgery.

[35]  D A Asch,et al.  The Libby Zion case. One step forward or two steps backward? , 1988, The New England journal of medicine.

[36]  Aimin Zhang,et al.  Construct validity testing of a laparoscopic surgery simulator (Lap Mentor®) , 2008, Surgical Endoscopy.

[37]  James R Korndorffer,et al.  Simulator training for laparoscopic suturing using performance goals translates to the operating room. , 2005, Journal of the American College of Surgeons.

[38]  A. Gallagher,et al.  An ergonomic analysis of the fulcrum effect in the acquisition of endoscopic skills. , 1998, Endoscopy.

[39]  Paul G Gauger,et al.  Laparoscopic Skills Are Improved With LapMentor™ Training: Results of a Randomized, Double-Blinded Study , 2006, Annals of surgery.

[40]  F.E. Zajac,et al.  An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures , 1990, IEEE Transactions on Biomedical Engineering.

[41]  A. Darzi,et al.  Skill transfer from virtual reality to a real laparoscopic task , 2001, Surgical Endoscopy.

[42]  R. M. Satava,et al.  PicSOr: An objective test of perceptual skill that predicts laparoscopic technical skill in three initial studies of laparoscopopic performance , 2003, Surgical Endoscopy And Other Interventional Techniques.

[43]  James R Korndorffer,et al.  Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. , 2006, Surgery.

[44]  D. Scott,et al.  Construct and face validity of MIST-VR, Endotower, and CELTS , 2005, Surgical Endoscopy And Other Interventional Techniques.

[45]  Melina C Vassiliou,et al.  Sim one, do one, teach one: considerations in designing training curricula for surgical simulation. , 2011, Journal of surgical education.

[46]  Jeffrey A. Cadeddu,et al.  Training on a virtual reality laparoscopic simulator improves performance of an unfamiliar live laparoscopic procedure. , 2008, The Journal of urology.

[47]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[48]  Rajesh Aggarwal,et al.  Framework for systematic training and assessment of technical skills. , 2007, Journal of the American College of Surgeons.

[49]  A. Park,et al.  Transfer of training in acquiring laparoscopic skills. , 2001, Journal of the American College of Surgeons.

[50]  Leif Hedman,et al.  Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. , 2007, American journal of surgery.

[51]  Daniel B. Jones,et al.  Improving operative performance using a laparoscopic hernia simulator. , 2001, American journal of surgery.

[52]  Ronald C Merrell,et al.  Training in laparoscopic suturing skills using a new computer-based virtual reality simulator (MIST-VR) provides results comparable to those with an established pelvic trainer system. , 2002, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[53]  Frances Lawrenz,et al.  A unified approach to validation, reliability, and education study design for surgical technical skills training. , 2010, Archives of surgery.

[54]  Teodor P Grantcharov,et al.  Learning curves and impact of previous operative experience on performance on a virtual reality simulator to test laparoscopic surgical skills. , 2003, American journal of surgery.

[55]  Richard M Satava,et al.  Virtual reality surgical simulator: the first steps. 1993. , 2006, Clinical orthopaedics and related research.

[56]  Timothy D Lee,et al.  Learning to Use Minimal Access Surgical Instruments and 2-Dimensional Remote Visual Feedback: How Difficult is the Task for Novices? , 2002, Advances in health sciences education : theory and practice.

[57]  Daniel B. Jones,et al.  Laparoscopic training on bench models: better and more cost effective than operating room experience? , 2000, Journal of the American College of Surgeons.

[58]  A. Gallagher,et al.  Virtual reality training improves junior residents’ operating room performance: Results of a prospective, randomized, double-blinded study of the complete laparoscopic cholecystectomy , 2004 .

[59]  A. Duffy,et al.  Construct validity for the LAPSIM laparoscopic surgical simulator , 2005, Surgical Endoscopy And Other Interventional Techniques.

[60]  Rajesh Aggarwal,et al.  A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. , 2006, American journal of surgery.

[61]  Dimitrios Stefanidis,et al.  Proficiency-Based Laparoscopic Simulator Training Leads to Improved Operating Room Skill That Is Resistant to Decay , 2008, Surgical innovation.

[62]  M. Schijven,et al.  Construct validity of the LapSim: Can the LapSim virtual reality simulator distinguish between novices and experts? , 2007, Surgical Endoscopy.