Virtual reality training improves operating room performance: results of a randomized, double-blinded study

Abstract

Objective: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment.

Summary background data: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study.

Methods: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80).

Results: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test).

Conclusions: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Figure 1. MIST VR screen appearance on “Manipulate and Diathermy” task. The sphere, which must be precisely positioned within a virtual cube, presents a target for the L-hook electrosurgery instrument. Objects may be positioned anywhere within the defined operating space.

Fig. 2. Results of fundamental abilities assessment. No significant differences were noted in visuospatial, perceptual, or psychomotor abilities between subjects randomized to ST and VR groups when assessed before the training phase of the study.

Figure 3. Mean duration of operative procedure for the VR and ST groups.

Figure 4. Total error number for each error type. LOP, lack of progress; GBI, gallbladder injury; LI, liver injury; intraperitoneal, incorrect plane of dissection; BNT, burn nontarget tissue; TT, tearing tissue; IOV, instrument out of view; AT, attending takeover. In all error categories except LI and TT, a greater number of errors were observed in the ST group than in the VR group.

Figure 5. Total number of errors scored per procedure for VR and ST groups. The mean number of errors per procedure was significantly greater in the ST group than in the VR group (P < .006).