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  • Ankita Mishra

Surgical Training - Can Virtual Reality Give Resident surgeon More Dexterity and Experience?

Latest developments in Science and Technology have led to a dramatic change and improvement in the healthcare system. With the emergence of surgical modalities like laparoscopy and minimally invasive surgery, there is an increase in demand for new innovative techniques to learn surgical skills.

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Limitations of the Traditional Teaching

  • Risk to patient's safety

  • Steep learning curve

  • Increase the duration of the training period

  • Lack of feedback analysis

  • Relies heavily on chance

  • Excessive workload

The Halstedian-based system of resident education which advocates "see one, do one, teach one" is slowly losing importance as it relies heavily on a chance for educational opportunities. Training is directly done in the Operation Room (OR) itself and a patient with a specific disease should be present in order to learn about the disease and interventions that are needed to be done for the particular patient. This old system is facing challenges in terms of time efficiency, cost, patient safety, and legal liability.

How is the training in Minimally invasive surgery different from open surgery?

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In open surgical procedures, the surgeon can directly guide the trainee and intervene if any complications occur but in laparoscopic and endoscopic procedures, the expert surgeon has no or limited control over what the trainee is doing so it becomes difficult to intervene if any complications were to arise putting the patient's safety at risk. There is also no feedback mechanism for the trainee to know and analyse mistakes done during the procedure.

The skills required for laparoscopic and minimally invasive surgeries are very different as compared to open surgical procedures because of the lack of tactile feedback, change from 3D to 2D visualization, and fulcrum effect. It requires psychomotor and hand-eye coordination. The training process takes 5 years or more.

According to studies, it takes a surgeon to perform around 30 laparoscopic cholecystectomies before declaring the surgeon competent to do the procedure.

If this conventional training process continues, learning new methods and training will become more and more difficult putting excess pressure on the consultants to train more trainees at a time in order to meet the current need of society.


How Virtual Reality Can Help in Surgical Training?

The introduction of VR simulators can change the training curricula of Surgery completely.

Simulation Laboratory

It is a healthcare learning space designed in order to provide an immersive learning experience for trainee doctors. With the help of VR, the trainee can practice various skills and procedures in the simulation lab which is a risk-free environment. It makes learning outside the operating room possible and we can say it counteracts the old notion of the Operation Room being the best learning place.

VR Surgical Trainers

In the simulation labs, the trainee can spend however much time that is needed for him/her to learn a particular technique until it is perfected. VR surgical trainers help to master the surgical skills by allowing them to learn the process in a stepwise manner of increasing difficulty instead of learning every aspect of new skills all at once in the operating room. Simulation provides a safe and risk-free environment for trainees to get control of visual-spatial, perceptual, and psychomotor difficulties associated with minimally invasive techniques.

Instant Feedback Mechanism

Feedback is information about a person's performance of a task in an effort to reach a goal. With VR and simulations, all the movements of the trainee can be recorded and immediate, objective and automated feedback can be delivered.

The errors are highlighted and allow trainees to assess, analyze and rectify them. This can be done even without the presence of an expert surgeon reducing the training pressure on the experts.

How should VR be incorporated into surgical training?

  1. The development of a structured curriculum-The training period should be spread out over a period of time in order to augment the learning process

  2. Stepwise training- Complex tasks should be divided into smaller components. The trainee should master each step separately which is in increasing difficulty level before proceeding to do the entire procedure all at once.

  3. Set down criteria to determine competence level- The competence standard should be based on both clinically established and simulator-generated data. The trainee should only be allowed to proceed in the real-life operating room once he/she has been assessed for skill mastery.

This brings us to our question - Can Virtual reality give resident surgeons more dexterity and expertise?

The Answer is Yes. It can be successfully used for laparoscopic and minimally invasive training curricula. It reduces the physical and mental workload on surgeons and helps to improve their surgical performance in the operation room. It can also be used to train surgeons to cope with other technical problems encountered during surgery simultaneously. With direct feedback from VR trainers along with instructor feedback from expert surgeons, deliberate practice of trainees, and early introduction of haptics in VR, it provides the needed dexterity and expertise.

 

References

  1. Kantamaneni, Ketan, et al. "Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review." Cureus 13.8 (2021). [Link]

  2. Gasperin, Bruno Della Mea et al. “Can Virtual Reality be as good as operating room training? Experience from a residency program in general surgeryArquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery vol. 31,4 e1397. 6 Dec. 2018, DOI: 10.1590/0102-672020180001e1397.

  3. Buckley, C.E. et al. "Virtual Reality – A New Era in Surgical Training". Virtual Reality in Psychological, Medical and Pedagogical Applications, edited by Christiane Eichenberg, IntechOpen, 2012. DOI: 10.5772/46415



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