Virtual Reality Simulation Training Research Articles

Virtual reality simulator for training on photoselective vaporization of the prostate with 980 nm diode laser and learning curve of the technique

ObjectiveThe utility of a virtual reality simulator for training of the photoselective vaporization of the prostate with diode laser was studied. Materials and methodsTwo experiments were performed with a simulator (VirtaMed AG, Zürich, Switzerland) with software for specific training in prostate vaporization in contact mode with Twister fiber (Biolitec AG, Jena, German). Eighteen surgeons performed ablation of the prostate (55cc) twice and compared the score obtained (190 points efficacy and 80 safety) in the second one of them by experience groups (medical students, residents, specialists). They also performed a spatial orientation test with scores of 0–6. After, six of these surgeons repeated 15 ablations of the prostate (55 and 70ml). Improvement of the parameters obtained was evaluated to define the learning curve and how experience, spatial orientation skills and type of sequences performed affects them. ResultsGlobal efficacy and safety score were different according to the grade of experience (P=.005). When compared by pairs, specialist-student differences were detected (p=0.004), but not specialist-resident (P=.12) or resident-student (P=.2). Regarding efficacy of the procedure, specialist-student (p=0.0026) and resident-student (P=.08) differences were detected. The different partial indicators in terms of efficacy were rate of ablation (P=.01), procedure time (P=.03) and amount of unexposed capsule (p=0.03). Differences were not observed between groups in safety (P=.5). Regarding the learning curve, percentage median on the total score exceeded 90% after performing four procedures for prostates of 55ml and 10 procedures for prostate glands of 70ml. This course was not modified by previous experience (resident-specialist; P=.6). However, it was modified according to the repetition sequence (progressive-random; P=.007). Surgeons whose spatial orientation was less than the median of the group (value 2.5) did not surpass 90% of the score in spite of repetition of the procedure. ConclusionSimulation for ablation of the prostate with contact diode laser is a good learning model with discriminative validity, as it correlates the metric results with levels of experience and skills. The sequential repetition of the procedure on growing levels of difficulty favors learning.

Single-Session Baseline Virtual Reality Simulator Scores Predict Technical Performance for Laparoscopic Colectomy: A Study in the Swine Model

Virtual reality (VR) simulation helps reducing the learning curve of laparoscopic colectomy. Moreover, it may be used to ascertain surgeons' pretraining skills. It was aimed to establish predictive validity of specific parameters gathered during VR simulation training on sigmoid colectomy and whether simulator parameters correlate with technical performance during the same operation in a swine model. Surgeons novice to laparoscopic colectomy underwent a single VR simulation session on sigmoid colectomy. Next, all participants performed a laparoscopic sigmoidectomy in the swine. Operations were recorded. Performance evaluation was conducted by 2 board-certified colorectal surgeons blinded to surgeons' simulator scores using an instrument specific to laparoscopic colectomy. For each participant, a mean score of specific skills was calculated. Linear regression analysis was used to identify simulator parameters that were best related to the score. The stepwise method was used to select parameters. The magnitude of the regression model was measured by the coefficient of determination (R(2)) value. The University of Sao Paulo Medical Center is a high-volume, public practice, university-affiliated hospital. A total of 14 first-year residents in digestive tract surgery were included. Analysis of variance demonstrated that the regression model was significant (p = 0.0001), and an association between simulation scores and specific skills was confirmed. The R(2) value was 99%. The VR simulator parameters that strongly correlated with specific skills during laparoscopic colectomy in the swine were safe use of electrosurgery/energy device and safety of medial-to-lateral dissection. A single VR simulation session for novice surgeons in the sigmoid colectomy module generates baseline scores that highly correlated with performance of specific skills during a laparoscopic colectomy in the swine. This information may be useful in an attempt to tailor VR simulator practice according to a surgeon's needs.

Validation of the ArthroS virtual reality simulator for arthroscopic skills.

Virtual reality simulator training has become important for acquiring arthroscopic skills. A new simulator for knee arthroscopy ArthroS™ has been developed. The purpose of this study was to demonstrate face and construct validity, executed according to a protocol used previously to validate arthroscopic simulators. Twenty-seven participants were divided into three groups having different levels of arthroscopic experience. Participants answered questions regarding general information and the outer appearance of the simulator for face validity. Construct validity was assessed with one standardized navigation task. Face validity, educational value and user friendliness were further determined by giving participants three exercises and by asking them to fill out the questionnaire. Construct validity was demonstrated between experts and beginners. Median task times were not significantly different for all repetitions between novices and intermediates, and between intermediates and experts. Median face validity was 8.3 for the outer appearance, 6.5 for the intra-articular joint and 4.7 for surgical instruments. Educational value and user friendliness were perceived as nonsatisfactory, especially because of the lack of tactile feedback. The ArthroS™ demonstrated construct validity between novices and experts, but did not demonstrate full face validity. Future improvements should be mainly focused on the development of tactile feedback. It is necessary that a newly presented simulator is validated to prove it actually contributes to proficiency of skills.

Simulador de realidad virtual para el entrenamiento en vaporización fotoselectiva de la próstata con láser de diodo 980 nm y curva de aprendizaje de la técnica

ObjectiveThe utility of a virtual reality simulator for training of the photoselective vaporization of the prostate with diode laser was studied. Material and methodTwo experiments were performed with a simulator (VirtaMed AG, Zürich, Switzerland) with software for specific training in prostate vaporization in contact mode with Twister fiber (Biolitec AG, Jena, German). Eighteen surgeons performed ablation of the prostate (55cc) twice and compared the score obtained (190 points efficacy and 80 safety) in the second one of them by experience groups (medical students, residents, specialists). They also performed a spatial orientation test with scores of 0 to 6. After, six of these surgeons repeated 15 ablations of the prostate (55 and 70ml). Improvement of the parameters obtained was evaluated to define the learning curve and how experience, spatial orientation skills and type of sequences performed affects them. ResultsGlobal efficacy and safety score was different according to the grade of experience (P=.005). When compared by pairs, specialist-student differences were detected (p=0.004), but not specialist-resident (P=.12) or resident-student (P=.2). Regarding efficacy of the procedure, specialist-student (p=0.0026) and resident-student (P=.08) differences were detected. The different partial indicators in terms of efficacy were rate of ablation (P=.01), procedure time (P=.03) and amount of unexposed capsule (p=0.03). Differences were not observed between groups in safety (P=.5). Regarding the learning curve, percentage median on the total score exceeded 90% after performing 4 procedures for prostates of 55ml and 10 procedures for prostate glands of 70ml. This course was not modified by previous experience (resident-specialist; P=.6). However, it was modified according to the repetition sequence (progressive-random; P=.007). Surgeons whose spatial orientation was less than the median of the group (value 2.5) did not surpass 90% of the score in spite of repetition of the procedure. ConclusionSimulation for ablation of the prostate with contact diode laser is a good learning model with discriminative validity, as it correlates the metric results with levels of experience and sills. The sequential repetition of the procedure on growing levels of difficulty favors learning.

Short-duration virtual reality simulation training positively impacts performance during laparoscopic colectomy in animal model: results of a single-blinded randomized trial

Several studies have demonstrated skills transfer after virtual reality (VR) simulation training in laparoscopic surgery. However, the impact of VR simulation training on transfer of skills related to laparoscopic colectomy remains not investigated. The present study aimed at determining the impact of VR simulation warm-up on performance during laparoscopic colectomy in the porcine model. Fourteen residents naive to laparoscopic colectomy as surgeons were randomly assigned in block to two groups. Seven trainees completed a 2-h VR simulator training in the laparoscopic sigmoid colectomy module (study group). The remaining seven surgeons (control group) underwent no intervention. On the same day, all participants performed a sigmoid colectomy with anastomosis on a pig. All operations were video recorded. Two board-certified expert colorectal surgeons independently assessed performance during the colectomy on the swine. Examiners were blinded to group assignment. The two examiners used a previously validated clinical instrument specific to laparoscopic colectomy. The primary outcome was the generic and specific skills score values. Surgeons undergoing short-duration training on the VR simulator performed significantly better during laparoscopic colectomy on the pig regarding general and specific technical skills evaluation. The average score of generic skills was 17.2 (16.5-18) for the control group and 20.1 (16.5-22) for the study group (p=0.002). The specific skills average score for the control group was 20.2 (19-21.5) and 24.2 (21-27.5) for the study group (p=0.001). There was acceptable concordance (Kendall'sW) regarding the video assessment of generic (W=0.78) and specific skills (W=0.84) between the two examiners. A single short-duration VR simulator practice positively impacted surgeons' generic and specific skills performance required to accomplish laparoscopic colectomy in the swine model.

Simulation and Evaluation of a Bone Sawing Procedure for Orthognathic Surgery Based on an Experimental Force Model

Bone sawing is widely used in orthognathic surgery to correct maxillary deformities. Successful execution of bone sawing requires a high level of dexterity and experience. A virtual reality (VR) surgical simulator can provide a safe, cost-effective, and repeatable training method. In this study, we developed a VR training simulator with haptic functions to simulate bone-sawing force, which was generated by the experimental force model. Ten human skulls were obtained in this study for the determination of surgical bone-sawing force. Using a 5-DOF machining center and a micro-reciprocating saw, bone specimens with different bone density were sawed at different feed rates (20, 40, and 60 mm/min) and spindle speeds (9800, 11,200 and 12,600 cycles per minute). The sawing forces were recorded with a piezoelectric dynamometer and a signal acquisition system. Linear correlation analysis of all experimental data indicates that there were significant positive linear correlations between bone-sawing force and bone density and tool feed rate and a moderate negative linear correlation with tool spindle rate. By performing multiple regression analysis, the prediction models for the bone-sawing procedure were determined. By employing Omega.6 as a haptic device, a medical simulator for the Lefort I osteotomy was developed based on an experimental force model. Comparison of the force-time curve acquired through experiments and the curve computed from the simulator indicate that the obtained forces based on the experimental force model and the acquired data had the same trend for the bone-sawing procedure of orthognathic surgery.

Development of a knowledge, skills, and attitudes framework for training in laparoscopic cholecystectomy

BackgroundThe implementation of duty-hour restrictions and a heightened awareness of patient safety has changed resident education and training. A new focus has been placed on high-yield training programs and simulation training has naturally grown to fill this need. MethodsThis article discusses the development of a training framework, knowledge, skills, and attitudes, and the design of a surgical simulation curriculum. Five residents were recruited for a pilot study of the curriculum. ResultsA successful framework for curriculum development was implemented using laparoscopic cholecystectomy as the example. The curriculum consisted of classroom and virtual reality simulation training and was completed in 3.1 to 4.8 hours. ConclusionsThe current curricula that have been developed for surgical education cover the breadth of a surgical residency well. This curriculum went beyond these curricula and developed a structured framework for surgical training, a method that can be applied to any procedure.

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management

Background Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen. Methods Thirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes. Results Significant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs. 0.97±0.76) and GRS (29.27±2.95 vs. 9.87±2.21). The differences between the first and the second assessment were all statistically significant (all P <0.01). Conclusion The virtual reality simulator training program can help the trainees to rapidly improve their retrograde flexible ureteroscopy skill in renal stone treatment.

Laparoscopic skills acquisition: Box trainer, virtual reality simulator or mental training?

Laparoscopic skills acquisition: Box trainer, virtual reality simulator or mental training?

Robotic Virtual Reality Simulation Plus Standard Robotic Orientation Versus Standard Robotic Orientation Alone

The objective of this study was to compare the effect of virtual reality simulation training plus robotic orientation versus robotic orientation alone on performance of surgical tasks using an inanimate model. Surgical resident physicians were enrolled in this assessor-blinded randomized controlled trial. Residents were randomized to receive either (1) robotic virtual reality simulation training plus standard robotic orientation or (2) standard robotic orientation alone. Performance of surgical tasks was assessed at baseline and after the intervention. Nine of 33 modules from the da Vinci Skills Simulator were chosen. Experts in robotic surgery evaluated each resident's videotaped performance of the inanimate model using the Global Rating Scale (GRS) and Objective Structured Assessment of Technical Skills-modified for robotic-assisted surgery (rOSATS). Nine resident physicians were enrolled in the simulation group and 9 in the control group. As a whole, participants improved their total time, time to incision, and suture time from baseline to repeat testing on the inanimate model (P = 0.001, 0.003, <0.001, respectively). Both groups improved their GRS and rOSATS scores significantly (both P < 0.001); however, the GRS overall pass rate was higher in the simulation group compared with the control group (89% vs 44%, P = 0.066). Standard robotic orientation and/or robotic virtual reality simulation improve surgical skills on an inanimate model, although this may be a function of the initial "practice" on the inanimate model and repeat testing of a known task. However, robotic virtual reality simulation training increases GRS pass rates consistent with improved robotic technical skills learned in a virtual reality environment.

Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve

Medical literature is scarce on information to define a basic skills training program for laparoscopic surgery (peg and transferring, cutting, clipping). The aim of this study was to determine the minimal number of simulator sessions of basic laparoscopic tasks necessary to elaborate an optimal virtual reality training curriculum. Eleven medical students with no previous laparoscopic experience were spontaneously enrolled. They were submitted to simulator training sessions starting at level 1 (Immersion Lap VR, San Jose, CA), including sequentially camera handling, peg and transfer, clipping and cutting. Each student trained twice a week until 10 sessions were completed. The score indexes were registered and analyzed. The total of errors of the evaluation sequences (camera, peg and transfer, clipping and cutting) were computed and thereafter, they were correlated to the total of items evaluated in each step, resulting in a success percent ratio for each student for each set of each completed session. Thereafter, we computed the cumulative success rate in 10 sessions, obtaining an analysis of the learning process. By non-linear regression the learning curve was analyzed. By the non-linear regression method the learning curve was analyzed and a r2 = 0.73 (p < 0.001) was obtained, being necessary 4.26 (∼five sessions) to reach the plateau of 80% of the estimated acquired knowledge, being that 100% of the students have reached this level of skills. From the fifth session till the 10th, the gain of knowledge was not significant, although some students reached 96% of the expected improvement. This study revealed that after five simulator training sequential sessions the students' learning curve reaches a plateau. The forward sessions in the same difficult level do not promote any improvement in laparoscopic basic surgical skills, and the students should be introduced to a more difficult training tasks level.

Research on the Virtual Reality Training Simulation Technology Based on Key Technology of Physical Simulation

Through computer-related technologies, virtual reality allows the user to appreciate the induction of vision, auditory, tactile sensor and immersive feel in an interactive virtual environment. Because of the above-mentioned features, it has become one of the hot topics of the direction quickly. This paper discusses virtual reality simulation system, takes sports training simulation as an example, analyzes its key technologies and makes more people to understand the virtual reality simulation system. It provides some scientific ideas for the combination of virtual reality simulation with many other areas of development. The discussions about the key technology of virtual reality simulation system in this paper provide some reference for the development of many other cross-cutting areas combined with the virtual reality to a certain extent.

Implementation of laparoscopic virtual-reality simulation training in gynaecology: a mixed-methods design

ObjectivesVirtual-reality (VR) training has been demonstrated to improve laparoscopic surgical skills in the operating theatre. The incorporation of laparoscopic VR simulation into surgical training in gynaecology remains a significant educational challenge. We undertook a pilot study to assess the feasibility of the implementation of a laparoscopic VR simulation programme into a single unit. Study designAn observational study with qualitative analysis of semi-structured group interviews. Trainees in gynaecology (n=9) were scheduled to undertake a pre-validated structured training programme on a laparoscopic VR simulator (LapSim®) over six months. The main outcome measure was the trainees’ progress through the training modules in six months. Trainees’ perceptions of the feasibility and barriers to the implementation of laparoscopic VR training were assessed in focus groups after training. ResultsSixty-six percent of participants completed six of ten modules. Overall, feedback from the focus groups was positive; trainees felt training improved their dexterity, hand-eye co-ordination and confidence in theatre. Negative aspects included lack of haptic feedback, and facility for laparoscopic port placement training. Time restriction emerged as the main barrier to training. ConclusionsDespite positive perceptions of training, no trainee completed more than two-thirds of the modules of a self-directed laparoscopic VR training programme. Suggested improvements to the integration of future laparoscopic VR training include an additional theoretical component with a fuller understanding of benefits of VR training, and scheduled supervision. Ultimately, the success of a laparoscopic VR simulation training programme might only be improved if it is a mandatory component of the curriculum, together with dedicated time for training. Future multi-centred implementation studies of validated laparoscopic VR curricula are required.

A Low-Cost Computer Vision Based Approach for Tracking Surgical Robotic Tools

The number of Robot-Assisted Minimally Invasive Surgery (RMIS) procedures has grown immensely in recent years. The number of surgeries performed with the da Vinci (Intuitive Surgical, Sunnyvale, CA) worldwide in 2005 was under 50,000. This number grew to more than 350,000 by 2011 [1]. RMIS procedures provide improved patient recovery time and reduced trauma due to smaller incisions relative to traditional open procedures. Given the rise in RMIS procedures, several organizations and companies have made efforts to develop training and certification criteria for the da Vinci robot. Mimic technologies (Mimic, Seattle, WA) and Intuitive Surgical both produce virtual reality (VR) training simulators based on the da Vinci system. The Fundamentals of Robotic Surgery (FRS) consortium has been created with the goal of developing a standardized, high-stakes certification exam for robotic surgery [1]. While still in the development stage, this exam will consist of seven tasks carried out on a small physical module with an actual RMIS system. Each task is evaluated with a certain set of criteria including completion time, total tool path length and economy of motion, which is a measurement of deviation from an ‘ideal’ path. All of these metrics can benefit greatly from an accurate, inexpensive and modular tool tracking system that requires no modification to the existing robot. While the da Vinci uses joint kinematics to calculate the tool tip position and movement internally, this data is not openly available to users. Even if this data was open to researchers, the accuracy of kinematic calculations of end effector position suffers from compliance in the joints and links of the robot as well as finite uncertainties in the sensors. In order to find an accurate, available and low-cost alternative to tool tip localization, we have developed a computer vision based design for surgical tool tracking. Vision systems have the added benefit of being low cost with typical high resolution webcams costing around $50. The stereo setup for this design cost around $120. Chmarra et al. reviewed the available non-robotic, laparoscopic tracking devices in 2007 and discussed 4 main technologies for tracking; mechanical, visual, ultrasonic, and electromagnetic [2]. From this work, it became apparent that in order to track robotic tools, only the visual or ultrasound-based methods would be feasible. The goal of our research was to develop a tracking system which could accompany the FRS module or be used separately during real procedures to gauge performance post-procedure using the da Vinci camera feed. The system was designed to use only a camera setup and a computer loaded with the computer vision software. Given the bandwidth of surgical tool motions has been experimentally determined as falling below 8 Hz [3], we adopt 16 Hz, or frames per second (FPS), as a minimal frame rate required to accurately capture surgical tool motion data. 2 Methods

Prospective, Randomized Assessment of Transfer of Training (ToT) and Transfer Effectiveness Ratio (TER) of Virtual Reality Simulation Training for Laparoscopic Skill Acquisition

We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. Prospective, randomized, and blinded. In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32-42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). VR simulation training offers a powerful and effective platform for training safer skills.

Task Analysis for Developing Maintenance and Assembly VR Training Simulators

Task analysis for the development of a virtual reality (VR) training system requires analysis and identification of the operator’s interactions with the real-world system and of the objectives of training and the trainee’s skill acquisition requirements. A task analysis approach for developing VR training simulators is presented that is based on analyzing the technology and training requirements concurrently. This approach is compared with traditional approaches for system development, with examples provided from the development of a VR training simulator for industrial maintenance and assembly tasks.

Needs assessment for simulation training in neuroendoscopy: a Canadian national survey

In recent years, dramatic changes in surgical education have increased interest in simulation-based training for complex surgical skills. This is particularly true for endoscopic third ventriculostomy (ETV), given the potential for serious intraoperative errors arising from surgical inexperience. However, prior to simulator development, a thorough assessment of training needs is essential to ensure development of educationally relevant platforms. The purpose of this study was to conduct a national needs assessment addressing specific goals of instruction, to guide development of simulation platforms, training curricula, and assessment metrics for ETV. Canadian neurosurgeons performing ETV were invited to participate in a structured online questionnaire regarding the procedural steps for ETV, the frequency and significance of intraoperative errors committed while learning the technique, and simulation training modules of greatest potential educational benefit. Descriptive data analysis was completed for both quantitative and qualitative responses. Thirty-two (55.2%) of 58 surgeons completed the survey. All believed that virtual reality simulation training for ETV would be a valuable addition to clinical training. Selection of ventriculostomy site, navigation within the ventricles, and performance of the ventriculostomy ranked as the most important steps to simulate. Technically inadequate ventriculostomy and inappropriate fenestration site selection were ranked as the most frequent/significant errors. A standard ETV module was thought to be most beneficial for resident training. To inform the development of a simulation-based training program for ETV, the authors have conducted a national needs assessment. The results provide valuable insight to inform key design elements necessary to construct an educationally relevant device and educational program.

The State of Simulation in Endoscopy Education: Continuing to Advance Toward Our Goals

Since the introduction of flexible endoscopy in the late 1960s, training programs have faced challenges with endoscopy education. Among these hurdles of traditional endoscopic training are the negative financial impact training poses to a program (in the form of ecreased productivity and lost revenues), the increased isks to patient comfort and safety, as well as the adminstrative responsibility to ensure that competency by rainees is assessed and documented. Over the past deade, these hurdles have become even more challenging s procedure reimbursements have grown increasingly ighter and expectations to document quality and cometency metrics have grown. One potential answer to hese challenges is the use of simulation during training. ith the advent of computer simulation and ex vivo nimal models, there has been renewed interest and reearch in the area of endoscopy simulation with the opes of overcoming some of these hurdles by reducing raining duration, providing a risk-free environment for raining, and allowing for objective measures of skills and ompetency. Despite these research efforts, only a fracion of these hopes have been realized to date.

Integrative review: Virtual disaster training

Background: A critical component of disaster preparedness is the training of the healthcare workforce. Because livedisaster exercises are expensive and labor intensive, virtual reality simulation may offer a viable solution as a disastertraining method. The purpose of this integrative review was to examine the scientific evidence pertaining to the efficacy ofvirtual reality training in disaster training of healthcare workers. Inclusion criteria were: empiric literature focused on theuse of virtual reality simulation (VRS) in disaster training, written in English, peer-reviewed literature and publishedduring the time period of 2005-June, 2012. An exclusion criterion was the use of virtual simulation for modeling theeffects of disaster because these articles were not used for immersive training purposes. Methodology: A five-stage process was followed as the methodological strategy for the integrative review. These stagesincluded identification of the problem and purposes, a defined search strategy (method), evaluation and analysis of dataand the presentation of findings. A search of diverse databases was performed. These databases include PubMed, theCumulative Index of Nursing and Allied Healthcare Literature, Education Resources Information Center, AcademicSearch Complete, Computer Source, and Computer/Applied Science. Results: Principle findings identified three major themes including: descriptions of the participant’s VRS experiences,learning results after participation in VRS and an exploration of how knowledge construction occurs in the virtualenvironment. Eleven research articles were selected for inclusion in the review. Conclusions: The review found there are too few studies investigating the efficacy of VRS and disaster training. Rigorouslarger studies with measurement of long-term retention are needed. There is also a need to assess the self-efficacy to act indifferent types of disasters, and evaluate behavioral determinates such as performance in triage, decontamination, andtransport.

Virtual Reality Simulators Based on a Novel Robotic Catheter Operating System for Training in Minimally Invasive Surgery

Minimally invasive surgery is a specialized surgical technique that permits vascular interventions through very small incisions. This minimizes patients’ trauma and permits faster recovery compared to conventional surgery. The significant disadvantage of this surgical technique is, however, its complexity; therefore, it requires extensive training before surgery. In this paper, we presented virtual reality simulators for training with force feedback in minimally invasive surgery. This application allows generating realistic physicalbased models of catheters and blood vessels, and enables surgeons to touch, feel and manipulate virtual catheter inside a vascularmodel through the same surgical operation mode as is used in actual MIS. Experimental results show that the error rate is in an acceptable range and that simulators can be used for surgery training.