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. 2025 Mar;20(3):545-560.
doi: 10.1007/s11548-024-03291-z. Epub 2024 Nov 21.

Validity of a virtual reality-based straight coloanal anastomosis simulator

George Westergaard  1 , Alexis Desir  2 , Jacob Barker  3 , Tansel Halic  4 , Shruti Hegde  2 , Amr Al Abbas  2 , Javier Salgado Pogacnik  2 , James W Fleshman  5 , Ganesh Sankaranarayanan  2 , Suvranu De  6 , Doga Demirel  7
Affiliations

Validity of a virtual reality-based straight coloanal anastomosis simulator

George Westergaard et al. Int J Comput Assist Radiol Surg. 2025 Mar.

Abstract

Purpose: Current training methods for surgical trainees are inadequate because they are costly, low-fidelity, or have a low skill ceiling. This work aims to expand available virtual reality training options by developing a VR trainer for straight coloanal anastomosis (SCA), one of the Colorectal Objective Structured Assessment of Technical Skills (COSATS) tasks.

Methods: We developed a VR-based SCA simulator to evaluate trainees based on their performance. To increase the immersiveness, alongside the VR headset, we used haptics as the primary method of interaction with the simulation. We also implemented objective performance metrics to evaluate trainee performance throughout the simulation.

Results: We presented our performance metrics to 27 participants for an Expert Consensus Survey (5-point Likert scale) and created weights for our metrics. The weighted average scores for the 24 task-specific metrics ranged from 3.5 to 5. Additionally, for the general metrics, the scores spanned from 3.3 to 4.6. In the second phase of our study, we conducted a study with 16 participants (novice n = 9, expert n = 7). Based on the performance, experts outperformed novices by 8.56% when referring to the total score (p = 0.0041). Three of the measurable metrics, purse suture (p = 0.0797), retracting the anvil (p = 0.0738), and inserting the colonoscope (p = 0.0738) showed a significant difference between experts and novices. Experts were smoother with their hand motions by 3.67% per second and took 70.77% longer paths to complete the same tasks.

Conclusion: We created a high-fidelity coloanal anastomosis VR simulator. The simulator runs in real-time while allowing high immersion with a VR headset, deformable bodies, and a haptic device while providing objective feedback through performance metrics. Experts obtained higher scores throughout the simulation, including the quiz to demonstrate procedural knowledge, the metrics to demonstrate experience in steps/procedure, and control of their basic surgical skills and hand movements.

Keywords: COSATS; Coloanal anastomosis; Haptics; Surgical simulator; Virtual reality.

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Conflict of interest statement

Declarations. Conflict of interest: George Westergaard, Jacob Barker, Drs. Alexis Desir, Ganesh Sankaranarayanan, Tansel Halic, Shruti Hegde, Amr Al Abbas, Javier Salgado Pogacnik, James W. Fleshman, Doga Demirel, and Suvranu De have no conflicts of interest or financial ties to disclose. Ethical approval: This study was approved by the University of Texas Southwestern Institutional Review Board (IRB # STU-2021–0202). Informed consent: Informed consent was obtained from all participants included in the study.

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