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Face and construct validation of a next generation virtual reality (Gen2-VR©) surgical simulator

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Abstract

Introduction

Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR©) system to train surgeons in these environments. This study was to establish face and construct validity of our system.

Methods and procedures

The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: Case I: traditional VR; Case II: Gen2-VR© with no distractions and Case III: Gen2-VR© with distractions and interruptions. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 s and tools malfunctioned for 15 s at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study.

Results

Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.0001), (Case I, Case III, p < 0.0001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean 4.18) and tool malfunction (median 4.56) significantly hindered their performance.

Conclusion

The results showed that Gen2-VR© simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.

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References

  1. Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17(6):964–967

    Article  CAS  PubMed  Google Scholar 

  2. Arikatla VS, Sankaranarayanan G, Ahn W, Chellali A, De S, Caroline GL et al (2013) Face and construct validation of a virtual peg transfer simulator. Surg Endosc 27(5):1721–1729.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Duffy AJ, Hogle NJ, McCarthy H, Lew JI, Egan A, Christos P et al (2004) Construct validity for the LAPSIM laparoscopic surgical simulator. Surg Endosc 19(3):401–405

    Article  PubMed  Google Scholar 

  4. Shiralkar U (2011) Smart surgeons sharp decisions: cognitive skills to avoid errors and achieve results, 1st edn. Tfm Pub Ltd, Harley

    Google Scholar 

  5. Healey AN, Sevdalis N, Vincent CA (2006) Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics 49(5–6):589–604

    Article  CAS  PubMed  Google Scholar 

  6. Zheng B, Martinec DV, Cassera MA, Swanström LL (2008) A quantitative study of disruption in the operating room during laparoscopic antireflux surgery. Surg Endosc 22(10):2171–2177

    Article  PubMed  Google Scholar 

  7. Wiegmann DA, ElBardissi AW, Dearani JA, Daly RC, Sundt TM III (2007) Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery 142(5):658–665

    Article  PubMed  Google Scholar 

  8. Feuerbacher RL (2010) Effects of realistic distractions and interruptions on simulated surgical task performance (Internet), (cited 2012 May 30). Available from: http://ir.library.oregonstate.edu/xmlui/handle/1957/16171

  9. Lave J, Wenger E (1991) Situated learning: legitimate peripheral participation, 1st edn. Cambridge University Press, Cambridge

    Book  Google Scholar 

  10. Kim M-H, Park J, Rhee S-M, Park S-W (2007) An interactive virtual operating room. In: Koyamada K, Tamura S, Ono O (eds) Systems modeling and simulation (Internet). Springer Japan; 2007 (cited 2014 Jul 15) pp 342–346. Available from: http://link.springer.com.libproxy.rpi.edu/chapter/10.1007/978-4-431-49022-7_69

  11. Tsuda S, Scott D, Doyle J, Jones DB (2009) Surgical skills training and simulation. Curr Probl Surg 46(4):271–370

    Article  PubMed  Google Scholar 

  12. Arikatla VS, Ahn W, Sankaranarayanan G, De S (2013) Towards virtual FLS: development of a peg transfer simulator. Int J Med Robot 10(3):344–355.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Arikatla VS, Sankaranarayanan G, Ahn W, Chellali A, Cao CGL, De S (2013) Development and validation of VBLaST-PT©: a virtual peg transfer simulator. Stud Health Technol Inf 184:24–30

    Google Scholar 

  14. Chellali A, Zhang L, Sankaranarayanan G, Arikatla VS, Ahn W, Derevianko A et al (2014) Validation of the VBLaST peg transfer task: a first step toward an alternate training standard. Surg Endosc 28(10):2856–2862

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Hodge B, Thompson JF (1990) Noise pollution in the operating theatre. Lancet 335(8694):891–894

    Article  CAS  PubMed  Google Scholar 

  16. Hasfeldt D, Laerkner E, Birkelund R (2010) Noise in the operating room–what do we know? A review of the literature. J Perianesth Nurs 25(6):380–386

    Article  PubMed  Google Scholar 

  17. Pluyter JR, Buzink SN, Rutkowski A-F, Jakimowicz JJ (2010) Do absorption and realistic distraction influence performance of component task surgical procedure? Surg Endosc 24(4):902–907

    Article  PubMed Central  PubMed  Google Scholar 

  18. Persoon MC, Broos HJHP, Witjes JA, Hendrikx AJM, Scherpbier AJJM (2011) The effect of distractions in the operating room during endourological procedures. Surg Endosc 25(2):437–443

    Article  PubMed Central  PubMed  Google Scholar 

  19. Siu K-C, Suh IH, Mukherjee M, Oleynikov D, Stergiou N (2010) The impact of environmental noise on robot-assisted laparoscopic surgical performance. Surgery 147(1):107–113

    Article  PubMed  Google Scholar 

  20. Conrad C, Konuk Y, Werner P, Cao CG, Warshaw A, Rattner D et al (2010) The effect of defined auditory conditions versus mental loading on the laparoscopic motor skill performance of experts. Surg Endosc 24(6):1347–1352

    Article  PubMed  Google Scholar 

  21. Miskovic D, Rosenthal R, Zingg U, Oertli D, Metzger U, Jancke L (2008) Randomized controlled trial investigating the effect of music on the virtual reality laparoscopic learning performance of novice surgeons. Surg Endosc 22(11):2416–2420

    Article  CAS  PubMed  Google Scholar 

  22. Moorthy K, Munz Y, Undre S, Darzi A (2004) Objective evaluation of the effect of noise on the performance of a complex laparoscopic task. Surgery 136(1):25–30 (discussion 31)

    Article  CAS  PubMed  Google Scholar 

  23. Rauscher FH, Shaw GL, Ky CN (1993) Music and spatial task performance. Nature 365(6447):611

    Article  CAS  PubMed  Google Scholar 

  24. Siu K-C, Suh IH, Mukherjee M, Oleynikov D, Stergiou N (2010) The effect of music on robot-assisted laparoscopic surgical performance. Surg Innov 17(4):306–311

    Article  PubMed  Google Scholar 

  25. Goodell KH, Cao CGL, Schwaitzberg SD (2006) Effects of cognitive distraction on performance of laparoscopic surgical tasks. J Laparoendosc Adv Surg Tech 16(2):94–98

    Article  Google Scholar 

  26. Hsu KE, Man F-Y, Gizicki RA, Feldman LS, Fried GM (2008) Experienced surgeons can do more than one thing at a time: effect of distraction on performance of a simple laparoscopic and cognitive task by experienced and novice surgeons. Surg Endosc 22(1):196–201

    Article  CAS  PubMed  Google Scholar 

  27. Pashler H, Johnston JC, Ruthruff E (2001) Attention and Performance. Annu Rev Psychol 52(1):629–651

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the support of this work through NIH/NIBIB 2R01EB005807.

Disclosures

Dr. Daniel B. Jones is the chair of the SAGES FUSE committee and consultant to Allurion and Intuitive Surgical. Dr. Schwaitzberg has served on advisory panels and has received an honorarium from Stryker and Olympus. He has served on advisory panels for Neatstitch and Surgicquest, Arch Therapeutics Acuity Bio and Human Extensions. He has also received a Grant from Ethicon. Drs. Sankaranarayanan and De serve are members in the SAGES FUSE committee. Mr. Li, Manser, Drs. Caroline, G. L. Cao and Stephanie B. Jones have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA

    Ganesh Sankaranarayanan, Baichun Li & Suvranu De

  2. School of Mechanical Engineering and Automation, Northeastern University, Shenyang, People’s Republic of China

    Baichun Li

  3. Cambridge Health Alliance, Cambridge, MA, USA

    Kelly Manser & Steven Schwaitzberg

  4. Beth Israel Deaconess Medical Center, Boston, MA, USA

    Stephanie B. Jones & Daniel B. Jones

  5. Wright State University, Dayton, OH, USA

    Caroline G. L. Cao

  6. Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA

    Suvranu De

Authors
  1. Ganesh Sankaranarayanan
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  2. Baichun Li
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  3. Kelly Manser
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  4. Stephanie B. Jones
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  5. Daniel B. Jones
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  6. Steven Schwaitzberg
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  7. Caroline G. L. Cao
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  8. Suvranu De
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Correspondence to Suvranu De.

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Sankaranarayanan, G., Li, B., Manser, K. et al. Face and construct validation of a next generation virtual reality (Gen2-VR©) surgical simulator. Surg Endosc 30, 979–985 (2016). https://doi.org/10.1007/s00464-015-4278-7

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  • DOI: https://doi.org/10.1007/s00464-015-4278-7

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