O020 Does real-time surgical training on auxiliary screens affect performance and cognitive demands during surgery? a randomised crossover study on VR-simulated laparoscopic cholecystectomies.

Abstract

Abstract Introduction Technological innovations are pivotal to surgical training. It is unclear however, if these technologies deployed intra-operatively affect surgeon performance or cognitive burdens. Methods Ethical approval was gained from our institute. Forty-eight medical students, foundation, and core surgical doctors completed accredited eLearning on Laparoscopic cholecystectomy and basic laparoscopic skill modules on a VR-simulator. Operative workflows with step-by-step instructions to perform a level-1 laparoscopic cholecystectomy were prepared by expert surgeons. Participants were randomly allocated to complete the procedure with or without workflows, and then crossover twice, for a total of three cholecystectomies. After each simulation, participants completed a validated surgical task load index (SURG-TLX), measuring cognitive demands. After the study, they completed training evaluations. Screen-recordings of the procedures were blindly assessed by expert surgeons, using validated OSATS scores and procedure-specific performance and error scores (Eubanks et al, 1999). Statistical significance was defined with a p-value <0.05. Results Demographics did not differ significantly between groups. At the final attempt, OSATS were slightly improved, but not significantly, when using workflows (19 v. 17, p=0.9); as were performance scores (72 v. 71.5, p=0.73) and error scores (17 v. 22, p=0.268). Surg-TLX scores were also reduced although only significantly for Temporary-Demands (p=0.037). Procedure time was longer in the workflow group (20.5 v. 14 minutes, p=0.033). Above 90% of participants agreed workflows were enjoyable, user-friendly and aided learning. Conclusion Real-time operative workflows are perceived as useful learning adjuncts and may diminish cognitive burdens. Further research is needed to confirm if workflows improve performance and diminish errors. Take-home message In a VR simulated procedure, intra-operative surgical workflows do not seem to affect surgeon cognitive burden. OSATS, performance and error scores may be improved but further research is needed.