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Meta-Analysis
. 2022 Jul 7;6(4):zrac086.
doi: 10.1093/bjsopen/zrac086.

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials

Gemma Humm  1   2 , Helen Mohan  3 , Christina Fleming  4 , Rhiannon Harries  5 , Christopher Wood  6 , Khaled Dawas  2 , Danail Stoyanov  1 , Laurence B Lovat  1   2
Affiliations
Meta-Analysis

The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials

Gemma Humm et al. BJS Open. .

Abstract

Background: Simulation training can improve the learning curve of surgical trainees. This research aimed to systematically review randomized clinical trials (RCT) evaluating the performance of junior surgical trainees following virtual reality training (VRT) and other training methods in laparoscopic cholecystectomy.

Methods: MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Scopus and LILACS were searched for trials randomizing participants to VRT or no additional training (NAT) or simulation training (ST). Outcomes of interest were the reported performance using global rating scores (GRS), the Objective Structured Assessment of Technical Skill (OSATS) and Global Operative Assessment of Laparoscopic Skills (GOALS), error counts and time to completion of task during laparoscopic cholecystectomy on either porcine models or humans. Study quality was assessed using the Cochrane Risk of Bias Tool. PROSPERO ID: CRD42020208499.

Results: A total of 351 titles/abstracts were screened and 96 full texts were reviewed. Eighteen RCT were included and 15 manuscripts had data available for meta-analysis. Thirteen studies compared VRT and NAT, and 4 studies compared VRT and ST. One study compared VRT with NAT and ST and reported GRS only. Meta-analysis showed OSATS score (mean difference (MD) 6.22, 95%CI 3.81 to 8.36, P < 0.001) and time to completion of task (MD -8.35 min, 95%CI 13.10 to 3.60, P = <0.001) significantly improved after VRT compared with NAT. No significant difference was found in GOALS score. No significant differences were found between VRT and ST groups. Intraoperative errors were reported as reduced in VRT groups compared with NAT but were not suitable for meta-analysis.

Conclusion: Meta-analysis suggests that performance measured by OSATS and time to completion of task is improved with VRT compared with NAT for junior trainee in laparoscopic cholecystectomy. However, conclusions are limited by methodological heterogeneity and more research is needed to quantify the potential benefit to surgical training.

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Figures

Fig. 1
Fig. 1
PRISMA diagram
Fig. 2
Fig. 2
Risk of bias
Fig. 3
Fig. 3
Forest plot for metanalysis total Objective Structured Assessment of Technical Skills (OSATS) scores from randomized clinical trials comparing VR training (VRT) and no additional training (NAT)
Fig. 4
Fig. 4
Forest plot for metanalysis of Global Operative Assessment of Laparoscopic Skills (GOALS) scores from randomized clinical trials comparing VR training (VRT) and no additional training (NAT)
Fig. 5
Fig. 5
Forest plot for metanalysis time to completion of task (minutes) from randomized clinical trials comparing VR training (VRT) and no additional training (NAT)
Fig. 6
Fig. 6
Forest plot for metanalysis of scores from randomized clinical trials comparing VR training (VRT) and simulation training (ST)
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