Elsevier

Surgery

Volume 151, Issue 6, June 2012, Pages 779-784
Surgery

Simulation-Based Surgical Education
Can virtual reality simulation be used for advanced bariatric surgical training?

Presented at the Fourth Annual Meeting of the Consortium of ACS-accredited Education Institutes, April 29-30, 2011, Chicago, Illinois.
https://doi.org/10.1016/j.surg.2012.03.014Get rights and content

Introduction

Laparoscopic bariatric surgery is a safe and effective way of treating morbid obesity. However, the operations are technically challenging and training opportunities for junior surgeons are limited. This study aims to assess whether virtual reality (VR) simulation is an effective adjunct for training and assessment of laparoscopic bariatric technical skills.

Methods

Twenty bariatric surgeons of varying experience (Five experienced, five intermediate, and ten novice) were recruited to perform a jejuno-jejunostomy on both cadaveric tissue and on the bariatric module of the Lapmentor VR simulator (Simbionix Corporation, Cleveland, OH). Surgical performance was assessed using validated global rating scales (GRS) and procedure specific video rating scales (PSRS). Subjects were also questioned about the appropriateness of VR as a training tool for surgeons.

Results

Construct validity of the VR bariatric module was demonstrated with a significant difference in performance between novice and experienced surgeons on the VR jejuno-jejunostomy module GRS (median 11–15.5; P = .017) and PSRS (median 11–13; P = .003). Content validity was demonstrated with surgeons describing the VR bariatric module as useful and appropriate for training (mean Likert score 4.45/7) and they would highly recommend VR simulation to others for bariatric training (mean Likert score 5/7). Face and concurrent validity were not established.

Conclusion

This study shows that the bariatric module on a VR simulator demonstrates construct and content validity. VR simulation appears to be an effective method for training of advanced bariatric technical skills for surgeons at the start of their bariatric training. However, assessment of technical skills should still take place on cadaveric tissue.

Section snippets

Methods and materials

Twenty surgeons were recruited during a technical skills training course at Imperial College NHS trust. The participants were divided into expert, intermediate and novice groups depending on their previous laparoscopic surgical experience. Novice laparoscopic surgeons were defined by performing less than 75 basic laparoscopic procedures (laparoscopic cholecystectomy/appendectomy). Intermediate surgeons were defined by performing more than 75 basic laparoscopic procedures and more than 50

Results

Twenty surgeons of varying experience were recruited: 10 novice, 5 intermediate, and 5 expert laparoscopic surgeons.

Assessment of the performance of jejuno-jejunostomy on the VR simulator demonstrated construct validity with significant differences between novices and experts for both GRS (median 11–15.5; P = .017) and PSRS (median 11–13; P = .003). This was reciprocated between intermediate and expert surgeons, with significant difference in performance for GRS (median 12–15; P = .017) and

Discussion

The challenges faced by junior trainees trying to learn and develop laparoscopic technical skills are reciprocated for senior surgeons who have not had enough exposure to laparoscopic techniques. Simulation and in particular VR simulation has been heralded as potential adjunct to training for junior surgeons wishing to learn basic laparoscopic procedures.20, 21 However, effectiveness as an advanced surgical training tool has not yet been shown. One reason for this is the lack of validition for

References (28)

  • P. Schauer et al.

    The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases

    Surg Endosc

    (2003)
  • D. Oliak et al.

    Laparoscopic Roux-en-Y gastric bypass: defining the learning curve

    Surg Endosc

    (2003)
  • R. Aggarwal et al.

    Skills acquisition for laparoscopic gastric bypass in the training laboratory: an innovative approach

    Obes Surg

    (2007)
  • R. Aggarwal et al.

    Technical-skills training in the 21st century

    N Engl J Med

    (2006)

    • Cited by (14)

    • Current Status of Technical Skills Assessment Tools in Surgery: A Systematic Review

      2020, Journal of Surgical Research
      Citation Excerpt :

      Therefore, OSATS receives a level 1 recommendation. OSATS was utilized in combination with at least one other tool in 55 studies (18.2%)154-183,184-208 (Table 2). Test content was shown in thirteen studies (23.6%).

    • Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery

      2017, Journal of Clinical Neuroscience
      Citation Excerpt :

      Both AR and VR systems must be comfortable enough to wear for long periods of time, and the technology must achieve economies of scale so systems are affordable enough to be used in training and during procedures. Additionally, for VR and AR systems to be adopted into the surgical environment, reliability and validity measures must first be met (e.g. inter-rater and test–retest reliability, internal consistency, and face, content, convergent, discriminant, predictive and concurrent validity) to assure patient safety [23–28]. VR and AR have the potential to create enhanced learning environments compared to traditional pedagogic schemas.

    • Training in Bariatric Surgery

      2023, Obesity, Bariatric and Metabolic Surgery: A Comprehensive Guide: Second Edition

    • The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review

      2022, Surgical Endoscopy

    • Hierarchical task analysis of endoscopic sleeve gastroplasty

      2022, Surgical Endoscopy

    • Does rating with a checklist improve the effect of E-learning for cognitive and practical skills in bariatric surgery? A rater-blinded, randomized-controlled trial

      2019, Surgical Endoscopy
    View all citing articles on Scopus
    View full text
    Copyright © 2012 Published by Mosby, Inc.