Virtual Endoscopy Simulator Research Articles

Virtual reality tools for training in gastrointestinal endoscopy: A systematic review

BACKGROUND Virtual reality (VR) has emerged as an innovative technology in endoscopy training, providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills. This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. By examining the current state of the field, this review seeks to identify gaps, challenges, and opportunities for further research and implementation of VR in endoscopic training. METHODS The study is a systematic review, following the guidelines for reporting systematic reviews set out by the PRISMA statement. A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available, from electronic databases such as PubMed, Scopus, Cochrane, and Google Scholar. The results were systematically reviewed. RESULTS Sixteen articles were included in the final analysis. The total number of participants was 523. Five studies focused on both upper endoscopy and colonoscopy training, two on upper endoscopy training only, eight on colonoscopy training only, and one on sigmoidoscopy training only. Gastrointestinal Mentor virtual endoscopy simulator was commonly used. Fifteen reported positive results, indicating that VR-based training was feasible and acceptable for endoscopy learners. VR technology helped the trainees enhance their skills in manipulating the endoscope, reducing the procedure time or increasing the technical accuracy, in VR scenarios and real patients. Some studies show that the patient discomfort level decreased significantly. However, some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups. CONCLUSION VR training is effective for endoscopy training. There are several well-designed randomized controlled trials with large sample sizes, proving the potential of this innovative tool. Thus, VR should be more widely adopted in endoscopy training. Furthermore, combining VR training with conventional methods could be a promising approach that should be implemented in training.

Does Virtual Video Endoscopy simulation training aid postgraduate endoscopy trainee learning of pathology in the era of COVID-19?- A single centre experience in a Dublin Teaching Hospital

COVID-19 has had a significant impact on post-graduate gastrointestinal endoscopy education in Ireland. The signature pedagogy of endoscopy education is the hands-on apprenticeship model however this was impeded during the restrictions imposed by the pandemic. To progress endoscopy learning at a time when exposure was reduced, we, as consultant trainers, focused on teaching pathology recognition, a known deficit in the current endoscopy curriculum. A series of five virtual endoscopy simulation sessions consisting of endoscopic videos and pictures demonstrating upper gastrointestinal pathology were taught to six endoscopy trainee specialist registrars in a single Dublin teaching hospital. Pathology quizzes were administered to trainees pre and post undertaking the sessions to measure learning. Semi-structured interviews were used to assess the utility of the sessions and a qualitative analysis of responses was undertaken. Amongst the six trainees, virtual video endoscopy simulation training led to a statistically significant increase in endoscopy trainees’ pathology recognition scores in the post-intervention quiz. All trainees found the virtual video simulation sessions to be useful and relevant to their stage of training, with demonstration of active learning after the teaching sessions. However, the personal and professional effect of the pandemic on trainees was profound, with senior trainees being disproportionally affected. Trainees also identified that the current apprenticeship model for endoscopy learning is no longer fit for purpose. Given the effect of the pandemic on trainee learning it is important that we take a systematic approach to analyse teaching tools that were used during the pandemic to ensure that they are helping trainees reach their learning goals.

The Transantral Endoscopic Approach: A Portal for Masses of the Inferior Orbit-Improving Surgeons' Experience Through Virtual Endoscopy and Augmented Reality.

In the past years, endoscopic techniques have raised an increasing interest to perform minimally invasive accesses to the orbit, resulting in excellent clinical outcomes with inferior morbidities and complication rates. Among endoscopic approaches, the transantral endoscopic approach allows us to create a portal to the orbital floor, representing the most straightforward access to lesions located in the inferior orbital space. However, if endoscopic surgery provides enhanced magnified vision of the anatomy in a bloodless field, then it has several impairments compared with classic open surgery, owing to restricted operative spaces. Virtual surgical planning and anatomical computer-generated models have proved to be of great importance to plan endoscopic surgical approaches, and their role can be widened with the integration of surgical navigation, virtual endoscopy simulation, and augmented reality (AR). This study focuses on the strict conjugation between the technologies that allow the virtualization of surgery in an entirely digital environment, which can be transferred to the patient using intraoperative navigation or to a printed model using AR for pre-surgical analysis. Therefore, the interaction between different software packages and platforms offers a highly predictive preview of the surgical scenario, contributing to increasing orientation, awareness, and effectiveness of maneuvers performed under endoscopic guidance, which can be checked at any time using surgical navigation. In this paper, the authors explore the transantral approach for the excision of masses of the inferior orbital compartment through modern technology. The authors apply this technique for masses located in the inferior orbit and share their clinical results, describing why technological innovation, and, in particular, computer planning, virtual endoscopy, navigation, and AR can contribute to empowering minimally invasive orbital surgery, at the same time offering a valuable and indispensable tool for pre-surgical analysis and training.

Application of Virtual Endoscopy in Microvascular Decompression of Trigeminal Neuralgia.

The main purpose of this study is to evaluate the accuracy of virtual endoscopy (VE) in microvascular decompression (MVD) for the treatment of trigeminal neuralgia (TN). A total of 30 TN patients aged 42 to 70 years were recruited from January 2015 to January 2019, and all patients were confirmed to have severe neurovascular compression (NVC) (≥degree 2) by magnetic resonance tomographic angiography (MRTA). Preoperative MRTA and enhanced CT were performed, and the data were imported into Stlview software for VE simulation of MVD. The reliability of VE, real endoscopy, and MRTA in evaluating the degree and position of MVD in TN patients was compared. Virtual endoscopy is more reliable than MRTA in evaluating the degree of NVC, but both of them are reliable in determining the position of NVC in TN patients. Virtual endoscopy can be used in MVD for the treatment of TN, including preoperative diagnosis and risk evaluation, intraoperative guidance, and postoperative evaluation.

The application of virtual digestive endoscopy simulation system in gastroscopy skills teaching in infectious diseases specialized hospital

Endoscopic teaching has always been a difficult point in clinical medical skill teaching. A standardized teaching plan was set up for the beginners to learn gastroscopy skills, which took 16 weeks. This training program included teaching the basic structure of a gastroscopy, the theory of operation skills, cleaning and disinfection of gastroscopy, and the operation of the virtual digestion endoscopy simulation training system. Only by passing the examinations of what mentioned above, could a beginner do gastroscopy of clinical subjects and write reports. According to a questionnaire survey of 15 trainees, 100% of trainees believed that virtual digestive endoscopy was necessary for the teaching of endoscopic skills. It was believed that the teaching plan were very strict and strict with 63.3% and 33.3% respectively. Therefore, this teaching plan with higher recognition and acceptance is suitable for the clinicians specializing in liver diseases and infectious diseases in infectious diseases specialist hospitals, who want to learn gastroscopy skills. Key words: Digestive endoscopy; Gastroscopy; Physician training; Virtual endoscopic simulation training system

Exploration of microteaching combined with simulated endoscopy in the training quality of bronchoscopy

Bronchoscopy has been an important tool for clinicians. Based on the traditional training, this research tries to introduce microteaching combined with simulated bronchoscope, strengthens the chest CT reading training, standardizes operation practices, which significantly improve the operation speed, flexibility and accuracy, shorten the training cycle of the novices. This medical teaching method are effective to contribute the novices to master the operation skill of bronchoscopy. Key words: Bronchoscopy; Microteaching; Virtual endoscopy simulator; Medical education

Low-Cost Interactive Image-Based Virtual Endoscopy for the Diagnosis and Surgical Planning of Suprasellar Arachnoid Cysts

To investigate the feasibility and reliability of virtual endoscopy (VE) as a rapid, low-cost, and interactive tool for the diagnosis and surgical planning of suprasellar arachnoid cysts (SACs). Eighteen patients with SACs treated with endoscopic ventriculocystostomy were recruited, and 18 endoscopic patients treated with third ventriculostomy were randomly selected as a VE reconstruction control group. After loading their DICOM data into free 3D Slicer software, VE reconstruction was independently performed by 3 blinded clinicians and the time required for each reconstruction was recorded. Another 3 blinded senior neurosurgeons interactively graded the visibility of VE by watching video recordings of the endoscopic procedures. Based on the visibility scores, receiver operating characteristic curve analysis was used to investigate the reliability of VE to diagnose SACs, and Bland-Altman plots were used to assess the reliability of VE for surgical planning. In addition, the intraclass correlation coefficient was calculated to estimate the consistency among the results of 3 reconstruction performers. All 3 independent reconstructing performers successfully completed VE simulation for all cases, and the average reconstruction time was 10.2 ± 9.7 minutes. The area under the receiver operating characteristic curve of the cyst visibility score was 0.96, implying its diagnostic value for SACs. The Bland-Altman plot indicated good agreement between VE and intraoperative viewings, suggesting the anatomic accuracy of the VE for surgical planning. In addition, the intraclass correlation coefficient was 0.81, which revealed excellent interperformer consistency of our simulation method. This study substantiated the feasibility and reliability of VE as a rapid, low-cost, and interactive modality for diagnosis and surgical planning of SACs.

The Effect of Virtual Endoscopy Simulator Training on Novices: A Systematic Review

BackgroundAdvances in virtual endoscopy simulators have paralleled an interest in medical simulation for gastrointestinal endoscopy training.ObjectiveThe primary objective was to determine whether the virtual endoscopy simulator training could improve the performance of novices.DesignA systematic review.SettingRandomized controlled trials (RCTs) that compared virtual endoscopy simulator training with bedside teaching or any other intervention for novices were collected.PatientsNovice endoscopists.InterventionsThe PRISMA statement was followed during the course of the research. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ScienceDirect were searched (up to July 2013). Data extraction and assessment were independently performed.Main outcome measurementsIndependent procedure completion, total procedure time and required assistance.ResultsFifteen studies (n = 354) were eligible for inclusion: 9 studies designed for colonoscopy training, 6 for gastroscopy training. For gastroscopy training, procedure completed independently was reported in 87.7% of participants in simulator training group compared to 70.0% of participants in control group (1 study; 22 participants; RR 1.25; 95% CI 1.13–1.39; P<0.0001). For colonoscopy training, procedure completed independently was reported in 89.3% of participants in simulator training group compared to 88.9% of participants in control group (7 study; 163 participants; RR 1.10; 95% CI 0.88–1.37; P = 0.41; I 2 = 85%).LimitationsThe included studies are quite in-homogeneous with respect to training schedule and procedure.ConclusionsVirtual endoscopy simulator training might be effective for gastroscopy, but so far no data is available to support this for colonoscopy.

Effect of virtual endoscopy simulator training on performance of upper gastrointestinal endoscopy in patients: a randomized controlled trial

Skills in gastrointestinal endoscopy mainly depend on experience and practice. Patients upon whom trainees perform their first endoscopic examinations are likely to suffer more discomfort and prolonged procedures. Training on endoscopy simulators may reduce the time required to reach competency in patient endoscopy. Residents in internal medicine without experience of endoscopy were randomized to a group who trained on a simulator before conventional training (group S) or one that received conventional training only (group C) before starting upper gastrointestinal endoscopy in patients. After endoscopy, discomfort and pain were evaluated by patients, who were blind to the beginners' training status. Results in terms of time, technique (intubation, pyloric passage, J-maneuver), and diagnosis of pathological entities were evaluated by experts. From 2003 to 2007, 28 residents were enrolled. Comparing group S with group C in their first ten endoscopic examinations in patients, time taken to reach the duodenum (239 seconds (range 50 - 620) vs. 310 seconds (110 - 720; P < 0.0001) and technical accuracy ( P < 0.02) were significantly better in group S. Diagnostic accuracy did not differ between the groups. Fourteen residents (7 simulator-trained, 7 not simulator-trained) continued endoscopy training. After 60 endoscopic examinations, investigation time was still shorter in group S. Technical and diagnostic accuracy improved during on-patient training in both groups; here differences between groups were no longer observable. There were no significant differences in discomfort and pain scores between the groups after 10 and after 60 endoscopies. Discomfort and pain were higher than for endoscopy performed by experts. This randomized controlled trial shows that virtual simulator training significantly affects technical accuracy in the early and mid-term stages of endoscopic training. It helps reduce the time needed to reach technical competency, but clinically the effect is limited. Simulator training could be useful in an endoscopy training curriculum but cannot replace on-patient training.

Virtual Simulation of Neuroendoscopic Procedures: Early Clinical Experience with Ventricular Lesions

Virtual endoscopy (VE) is a new and promising imaging technology. Applied to neuroendoscopy it allows preoperative simulation of a procedure and evaluation of the individual intraventricular anatomy in selected cases. Along with neuronavigation and real time intraoperative imaging, VE is expected to improve the safety and efficacy of neuroendoscopic procedures. Between April 2003 and February 2004 VE simulation was performed in 13 randomly selected patients subjected to endoscopic procedures. Pathological entities included 4 cases with aqueduct stenosis, 4 with suprasellar arachnoid cysts, 2 tumors of the posterior third ventricle, 1 colloid cyst, 1 hyperplasia of the choroid plexus and 1 case with multiloculated hydrocephalus due to intraventricular septations. In 8 patients VE was accomplished preoperatively, in another 5 it was done after the operation, using data sets from neuronavigation imaging planning in 4 patients, and in one case using postoperative imaging studies. T (1)-weighted 3D image sets were acquired on a 1.5 T GE Genesis SIGNA MR scanner and VE reconstruction was performed using the General Electric Navigator software. The VE images were compared with the real images obtained during the endoscopic procedures and evaluated for their impact on the planning of the operative approach. VE implementation succeeded in all 13 patients. Major neuroanatomic reference structures were easily recognizable in all cases. Membranous structures such as the thinned floor of the third ventricle or cyst walls were identifiable in only 46 % of the cases. In 6 cases (46 %) VE showed anatomical variants and details relevant for the endoscopic procedure that were not identified on conventional MR images. VE has proved to be an important adjunct to the preoperative planning of neuroendoscopic procedures and its routine application is suggested.

Virtual Endoscopy Simulator: Can the Unexperienced Be Trained for Real Endoscopy?

Introduction: Virtual Endoscopy (GI-Mentor, Symbionix, Israel) is a new tool for preparation and skill training. The aim of the present study was to determine whether standardized virtual training can facilitate the first steps in clinical endoscopy. Methods: A total of 7 beginners (medical students) with no previous experience in GI endoscopy and 3 experts were included. All participants performed a psychomotoric skill test and a baseline test at the GI-Mentor including 2 therapeutic (treatment of ulcer bleeding) and 1 diagnostic (including tumor biopsies) EGD. The beginners were further trained (40 hours) and then re-evaluated. After finishing the virtual training the beginners performed a real EGD in patients. In both settings (live and virtual endoscopy) the parameters total time, time to reach the lower part of the duodenum, examined mucosal surface and efficiency were determined. Results: The beginners showed a significant improvement in Virtual Endoscopy after the training period (total time: 9 versus 4 minutes; time to reach second part of the duodenum: 3.39 versus 0.43 minutes; efficacy 64/96%). The results at the re-evaluation were comparable with the parameters of the experienced endoscopists and no significant differences were detected between the trained students and expert gastroenterologists. Furthermore, all beginners could finish the real endoscopy by themselves without significant help upon training with the Virtual Endoscopy Simulator. However, the endoscopic performance decreased compared to the Virtual training setting (total time 8 minutes; time to reach second part of the duodenum 3.25 minutes; efficacy 82%) probably due to differences between training situation and clinical setup. Discussion: Virtual training in GI Endoscopy is a valid tool for improving skill technique. The learning curve is rapid and after 40 hours training the performance of beginners and experienced endoscopists is comparable. Virtual endoscopy training prepares for live endoscopy and all beginners could perform their first endoscopic examination without significant help. However, due to disturbing factors in the clinical situation (patient and bowel movement; unfamiliar monitor noises) the live performance decreased, but is still better as compared to unexperienced endoscopists. Therefore, training with an endoscopy simulator might represent a new standard for gastroenterologists at the beginning of their endoscopic training in the near future.

Virtual endoscopy simulation for training of gastrointestinal endoscopy

Virtual endoscopy simulation for training of gastrointestinal endoscopy