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 level 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 hours a day for 5 days. Then, motion sickness was ascertained 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 seconds, p < 0.001). Although motion sickness worsened after each training session, continuous practice with the VR simulator gradually reduced this. SSQ subscores showed that the VR simulator elicited nausea, disorientation, and oculomotor strain, and oculomotor strain was significantly improved with repeated training. Conclusion In undergraduate students, practice with the VR simulator improved the technique of RAS and operator 3D motion sickness caused by 3D manipulation of the da Vinci robot.