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Journal ArticleDOI

Face and Construct Validity of a Novel Virtual Reality-Based Bimanual Laparoscopic Force-Skills Trainer With Haptics Feedback.

TL;DR: Competency-based laparoscopic skills assessment curriculum should be updated to meet the requirements of bimanual force-based training.
Abstract: Background. The purpose of this study was to examine the face and construct validity of a custom-developed bimanual laparoscopic force-skills trainer with haptics feedback. The study also examined ...
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Journal ArticleDOI
TL;DR: The development of VR technology has enabled the creation of the most comprehensive UXs, thus enhancing skill development, enabling remote access to training and, ultimately, improving patient safety.
Abstract: The aim of this integrative review was to analyse the usage of different virtual reality (VR) technologies in learning and user experiences (UXs) of these technologies in healthcare practice and ed...

54 citations

Journal ArticleDOI
TL;DR: In this article , brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six righthanded medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator.
Abstract: Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.

2 citations

Posted ContentDOI
21 Sep 2021-bioRxiv
TL;DR: In this paper, the authors employed portable optical neuroimaging technology and Granger causality approach to uncover the impact of the two medical simulation technologies on the directed functional brain network of the subjects with two different skill levels.
Abstract: Despite substantial progress towards establishing virtual reality (VR) simulators as a replacement for physical ones for skill training, its effect on the brain network during skill acquisition has not been well addressed. In this study, we employed portable optical neuroimaging technology and Granger causality approach to uncover the impact of the two medical simulation technologies on the directed functional brain network of the subjects with two different skill levels. The mobile brain-behavior relantionship was evaluated using functional near-infrared spectroscopy (fNIRS) while right-handed subjects performed well-established fundamentals of laparoscopic surgery (FLS) pattern cutting task. A multiple regression path analysis found that the cognitive-action information flow from the right prefrontal cortex to the supplementary motor area statistically significantly predicted the FLS task performance. Here, the skill level (expert vs novice) affected the cognitive-action information flow from the right prefrontal cortex and the efference copy information flow from the left primary motor cortex via supplementary motor area as hub to the cognitiveperception at the left prefrontal cortex, i.e., the action-preception link. The simulation technology (physical vs VR simulator) affected solely the cognitive-action information flow from the right prefrontal cortex to the left primary motor cortex; however, the interaction between the medical simulation technology) and the skill level affected the efference information flow from the left primary motor cortex to the right prefrontal cortex and from the supplementary motor area to the left prefrontal cortex. These discriminative findings are crucial since our VR simulator had face and construct validity. Therefore, our study highlighted the importance of efference information flow within the framework of the perception-action cycle when comparing medical simulation technology for visuomotor skill acquisition.

2 citations

Journal ArticleDOI
TL;DR: In this paper , brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six righthanded medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator.
Abstract: Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.

2 citations

Journal ArticleDOI
TL;DR: In this article , a literature review is conducted for an investigation of the current approaches for classifying the surgical skill levels and for identifying the skill training tools and measurement methods, and some inconsistencies are also identified across the skill level classification studies.
References
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Journal ArticleDOI
TL;DR: An inventory of 20 items with a set of instructions and response- and computational-conventions is proposed and the results obtained from a young adult population numbering some 1100 individuals are reported.

33,268 citations

Journal ArticleDOI
TL;DR: In this article, the use of VR surgical simulation to train skills and reduce error risk in the operating room (OR) has been demonstrated in a prospective, randomized, blinded stud.
Abstract: ObjectiveTo demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment.Summary Background DataThe use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded stud

2,597 citations

Journal ArticleDOI
TL;DR: A competency-based training curriculum for novice laparoscopic surgeons has been defined to ensure that junior trainees have acquired prerequisite levels of skill prior to entering the operating room, and put them directly into practice.
Abstract: The implementation of a competency-based surgical skills curriculum necessitates the development of tools to enable structured training, with in-built objective measures of assessment.1 Simulation in the form of virtual reality and synthetic models has been proposed for technical skills training at the early part of the learning curve.2–4 To be efficacious, these tools must convey a sense of realism and a degree of standardization to enable graded acquisition of technical skills. Progression along the curriculum is charted by passing predefined expert benchmark criteria, which lead to more technically demanding tasks. In the laparoscopic era, training on inanimate video trainers, and more recently on virtual reality simulators, has been shown to improve skills performance in the operating room.5,6 Nevertheless, structured training programs utilizing these tools do not exist and have not been validated in terms of which tasks should be performed, at which level, for how long, how often, and to which set of benchmark criteria The aim of this paper was to develop an evidence-based virtual reality training program for the initial acquisition of technical skill, leading to a basic level of proficiency prior to entering the operating theater. Basic and procedural tasks can be simulated in a high-fidelity virtual environment that closely resembles the operative field. Virtual tissues can be manipulated, clipped and cut, and incorporated into a recognizable simulation of Calot triangle dissection, which bleeds and can respond to diathermy (Figs. 1, 2). At the end of each task, performance can be measured using parameters such as time taken, number of errors made, and path length for each hand. This makes it possible to chart the performance of a trainee surgeon along the curriculum and define the attainment of proficiency. FIGURE 1. The “Cutting” task on the LapSim virtual reality simulator. FIGURE 2. The “Dissection” task on the LapSim virtual reality laparoscopic simulator. The structured curriculum can enable trainees to be confident in their skills prior to assisting in and performing the initial laparoscopic procedures, safe in the knowledge that they have achieved preset expert criteria. The ultimate aim is to reduce their learning curve on real patients, leading to acquisition of proficiency at an earlier stage than training on patients alone. Airline pilots become proficient at flying an aeroplane before even leaving the ground, acquiring skills on a high-fidelity flight simulator. The analogous situation should now be possible for the early part of the learning curve in laparoscopic surgery. This may lead to a reduction in the number of unnecessary complications occurring due to a failure of technical skills,7 and the time and expense spent acquiring basic laparoscopic skills in the operating room.8

319 citations

Journal ArticleDOI
TL;DR: Objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience is provided, which may influence the future development of training program for Laparoscopic surgery.
Abstract: Background: The impact of gender and hand dominance on operative performance may be a subject of prejudice among surgeons, reportedly leading to discrimination and lack of professional promotion. However, very little objective evidence is available yet on the matter. This study was conducted to identify factors that influence surgeons’ performance, as measured by a virtual reality computer simulator for laparoscopic surgery. Methods: This study included 25 surgical residents who had limited experience with laparoscopic surgery, having performed fewer than 10 laparoscopic cholecystectomies. The participants were registered according to their gender, hand dominance, and experience with computer games. All of the participants performed 10 repetitions of the six tasks on the Minimally Invasive Surgical Trainer—Virtual Reality (MIST-VR) within 1 month. Assessment of laparoscopic skills was based on three parameters measured by the simulator: time, errors, and economy of hand movement. Results: Differences in performance existed between the compared groups. Men completed the tasks in less time than women (p = 0.01, Mann–Whitney test), but there was no statistical difference between the genders in the number of errors and unnecessary movements. Individuals with right hand dominance performed fewer unnecessary movements (p = 0.045, Mann–Whitney test), and there was a trend toward better results in terms of time and errors among the residence with right hand dominance than among those with left dominance. Users of computer games made fewer errors than nonusers (p = 0.035, Mann–Whitney test). Conclusions: The study provides objective evidence of a difference in laparoscopic skills between surgeons differing gender, hand dominance, and computer experience. These results may influence the future development of training program for laparoscopic surgery. They also pose a challenge to individuals responsible for the selection and training of the residents.

246 citations

Journal ArticleDOI
TL;DR: This study confirmed the applicability and usefulness of an observational methodology in the assessment of human error in endoscopic surgical performance in order to identify underlying performance shaping factors (PSFs) and so reduce error rates.

228 citations