Novices outperform experienced laparoscopists on virtual reality laparoscopy simulator

Abstract

Background and objectives: Virtual reality has been poorly studied among gynecologic surgeons. The aim of this study was to evaluate whether performance on the Minimally Invasive Surgery Trainer-Virtual Reality (MIST-VR) laparoscopic trainer reflects laparoscopic experience among gynecologic surgeons and trainees.

Methods: Twenty-six medical students, residents, and attending gynecologic surgeons completed a MIST-VR training program. A new simulated task was then presented to each participant, who repeated the task until proficiency was reached.

Results: Attending physicians performed poorly when compared with medical students, requiring more than twice the number of attempts to reach proficiency (Mann-Whitney P<0.01). Among medical students and residents, there was an association between years of live laparoscopy experience and poor simulator performance (Spearman r P=0.01).

Conclusion: Increased operating room experience and age were associated with worsening simulator performance. Several potential explanations for this trend are discussed, including lack of tactile and contextual feedback. Caution should be exercised when considering current virtual reality simulator technology as a measure of experience or ability among gynecologic surgeons.

Figure 1.

MIST-VR, Manipulative Diathermy task. A sphere is grasped with virtual graspers and placed precisely inside a transparent cube. When the sphere is properly placed and held still inside the cube, a smaller cube appears on the side of the sphere. The virtual diathermy instrument is then placed inside of the smaller cube, and diathermy is applied with a mechanical pedal for a specified burn time. Each “attempt” consists of multiple repetitions of this task in varying spatial orientations.

Figure 2.

Attempts required to reach proficiency on MIST-VR manipulative diathermy task by years of live laparoscopy experience. Med students=0 years experience, PGY1=1 year experience.. Y4=4 years experience. Attendings not included. Linear regression P=0.01; F=8.4, degrees of freedom=1,17; r²=0.33.

Figure 3.

Attempts required to reach proficiency on MIST-VR manipulative diathermy task by age. Medical students, residents, and attendings included in analysis; 2-tailed t P<0.01, Spearman r=0.53.

Figure 4.

Average number of attempts required to reach proficiency on the MIST-VR manipulative diathermy task by participant group. *Mann-Whitney test: attending vs. medical student P=0.01, attending vs. resident P=0.14, resident vs. med student P=0.15.