The use of a virtual reality surgical simulator for cataract surgical skill assessment with 6 months of intervening operating room experience

Purpose To evaluate a haptic-based simulator, MicroVisTouch™, as an assessment tool for capsulorhexis performance in cataract surgery. The study is a prospective, unmasked, nonrandomized dual academic institution study conducted at the Wilmer Eye Institute at Johns Hopkins Medical Center (Baltimore, MD, USA) and King Khaled Eye Specialist Hospital (Riyadh, Saudi Arabia). Methods This prospective study evaluated capsulorhexis simulator performance in 78 ophthalmology residents in the US and Saudi Arabia in the first round of testing and 40 residents in a second round for follow-up. Results Four variables (circularity, accuracy, fluency, and overall) were tested by the simulator and graded on a 0–100 scale. Circularity (42%), accuracy (55%), and fluency (3%) were compiled to give an overall score. Capsulorhexis performance was retested in the original cohort 6 months after baseline assessment. Average scores in all measured metrics demonstrated statistically significant improvement (except for circularity, which trended toward improvement) after baseline assessment. A reduction in standard deviation and improvement in process capability indices over the 6-month period was also observed. Conclusion An interval objective improvement in capsulorhexis skill on a haptic-enabled cataract surgery simulator was associated with intervening operating room experience. Further work investigating the role of formalized simulator training programs requiring independent simulator use must be studied to determine its usefulness as an evaluation tool.

[1]  C. McCannel,et al.  Ophthalmic surgery simulator training improves resident performance of capsulorhexis in the operating room. , 2013, Ophthalmology.

[2]  Madeleine Selvander,et al.  Cataract surgeons outperform medical students in Eyesi virtual reality cataract surgery: evidence for construct validity , 2013, Acta ophthalmologica.

[3]  Anuja Bhandari,et al.  Virtual Reality Simulation in Acquiring and Differentiating Basic Ophthalmic Microsurgical Skills , 2009, Simulation in healthcare : journal of the Society for Simulation in Healthcare.

[4]  G. Saleh,et al.  The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies) , 2013, Eye.

[5]  L. Hedman,et al.  Simulator training and non‐technical factors improve laparoscopic performance among OBGYN trainees , 2013, Acta obstetricia et gynecologica Scandinavica.

[6]  Rajesh Aggarwal,et al.  Development of a training curriculum for microsurgery. , 2010, The British journal of oral & maxillofacial surgery.

[7]  Peter Åsman,et al.  Virtual reality cataract surgery training: learning curves and concurrent validity , 2012, Acta ophthalmologica.

[8]  G. Saleh,et al.  The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology , 2013, British Journal of Ophthalmology.

[9]  A. Darzi,et al.  Systematic Review on Mentoring and Simulation in Laparoscopic Colorectal Surgery , 2010, Annals of surgery.

[10]  J. Aucar,et al.  A Review of Surgical Simulation With Attention to Validation Methodology , 2005, Surgical laparoscopy, endoscopy & percutaneous techniques.

[11]  K. Reinig,et al.  Evaluation of skill level between trainees and community orthopaedic surgeons using a virtual reality arthroscopic knee simulator. , 2014, The Journal of bone and joint surgery. American volume.

[12]  Nick Sevdalis,et al.  The use of simulation in neurosurgical education and training. A systematic review. , 2014, Journal of neurosurgery.

[13]  Daniel Steen,et al.  Impact of simulator training on resident cataract surgery , 2013, Graefe's Archive for Clinical and Experimental Ophthalmology.

[14]  T. Oetting,et al.  Construct validity of a surgical simulator as a valid model for capsulorhexis training , 2010, Journal of cataract and refractive surgery.

[15]  Shameema Sikder,et al.  Validation of a Virtual Cataract Surgery Simulator for Simulation-Based Medical Education , 2013 .

[16]  S. Doi,et al.  Effect of the ACGME Duty Hours Restrictions on Surgical Residents and Faculty: A Systematic Review , 2011, Academic medicine : journal of the Association of American Medical Colleges.

[17]  C. Haisch,et al.  Accreditation Council for Graduate Medical Education Case Logs as an Indication of Operative Competency for Vascular Anastomoses: A Pilot Study , 2016 .

[18]  A. Darzi,et al.  Miskovic D, Wyles SM, Ni M, Darzi AW, Hanna GB. Ann Surg. 2010; 252(6):943-51. In the article Systematic Review on Mentoring and Simulation in Laparoscopic Colorectal Surgery the authors Danilo Miskovic and Susannah M Wyles should have been listed as , 2011 .

[19]  A. Darzi,et al.  Development of a virtual reality training curriculum for phacoemulsification surgery , 2014, Eye.

[20]  M. Daly,et al.  Efficacy of surgical simulator training versus traditional wet‐lab training on operating room performance of ophthalmology residents during the capsulorhexis in cataract surgery , 2013, Journal of cataract and refractive surgery.

[21]  David A Belyea,et al.  Influence of surgery simulator training on ophthalmology resident phacoemulsification performance , 2011, Journal of cataract and refractive surgery.

[22]  Shun Liang,et al.  Concurrent and Face Validity of a Capsulorhexis Simulation with Respect to Human Patients , 2012, MMVR.

[23]  M. A. Mahr,et al.  Construct validity of anterior segment anti‐tremor and forceps surgical simulator training modules: Attending versus resident surgeon performance , 2008, Journal of cataract and refractive surgery.