Abstract
PurposeTo evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons’ performance.MethodsIn a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.ResultsComparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.ConclusionsDespite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.
Highlights
Virtual reality education and training are established tools for building up expertise in many specialities worldwide, such as aviation or medicine.Khalifa et al [1] found that ophthalmology training programs were struggling to find viable methods of assessing and documenting the surgical skills of trainees, and that the role of virtual reality education and training in future curricula was still uncertain in 2006.Vitreoretinal surgery training with the ophthalmic surgical simulator Eyesi was introduced in June 2003 when two Eyesi simulators were used for the first time in a teaching lab, during the 5th International Vitreoretinal Symposium (VRS) in Frankfurt
Comparing each surgeon’s performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room
For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance
Summary
Vitreoretinal surgery training with the ophthalmic surgical simulator Eyesi was introduced in June 2003 when two Eyesi simulators were used for the first time in a teaching lab, during the 5th International Vitreoretinal Symposium (VRS) in Frankfurt. The success of this lab led to the introduction of the dry lab concept: simulation in combination with practice eyes, table microscopes and real surgical machines. Feudner et al [15] investigated how capsulorhexis training on Eyesi improved wetlab capsulorhexis performance of surgical novices, while McCannel et al [16] took a step forward by comparing the capsulorhexis performance of residents in the operating room before and after the introduction of simulator-based training and found a significant reduction in complications
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