Virtual Reality Simulation as a Tool to Monitor Surgical Performance Indicators: VIRESI Observational Study.

Abstract

Virtual reality simulation is a topic of discussion as a complementary tool to traditional laparoscopic surgical training inthe operating room. However, it is unclear whether virtual reality training can have an impact on the surgical performance of advancedlaparoscopic procedures. Our objective was to assess the ability of the virtual reality simulator LAP Mentor to identify and quantifychanges in surgical performance indicators, after LAP Mentor training for digestive anastomosis. Twelve surgeons from Centro Hospitalar de São João in Porto (Portugal) performed two sessions of advancedtask 5: anastomosis in LAP Mentor, before and after completing the tutorial, and were evaluated on 34 surgical performance indicators. The results show that six surgical performance indicators significantly changed after LAP Mentor training. The surgeonsperformed the task significantly faster as the median 'total time' significantly reduced (p < 0.05) from 759.5 to 523.5 seconds. Significantdecreases (p < 0.05) were also found in median 'total needle loading time' (303.3 to 107.8 seconds), 'average needle loading time'(38.5 to 31.0 seconds), 'number of passages in which the needle passed precisely through the entrance dots' (2.5 to 1.0), 'time theneedle was held outside the visible field' (20.9 to 2.4 seconds), and 'total time the needle-holders' ends are kept outside the predefinedoperative field' (88.2 to 49.6 seconds). This study raises the possibility of using virtual reality training simulation as a benchmark tool to assess the surgicalperformance of Portuguese surgeons. LAP Mentor is able to identify variations in surgical performance indicators of digestive anastomosis.