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Azher S, Mills A, He J, Hyjazie T, Tokuno J, Quaiattini A, Harley JM. Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review. Surg Innov 2024; 31:331-341. [PMID: 38486132 PMCID: PMC11047018 DOI: 10.1177/15533506241238263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Virtual simulations (VSs) enhance clinical competencies and skills. However, a previous systematic review of 9 RCT studies highlighted a paucity of literature on the effects of haptic feedback in surgical VSs. An updated systematic and scoping review was conducted to encompass more studies and a broader range of study methodologies. METHODS A systematic literature search was conducted on July 31, 2023, in MEDLINE, Embase, and Cochrane. English language studies comparing haptic vs non-haptic conditions and using VSs were included. Studies were evaluated and reported using PRISMA-ScR guidelines. RESULTS Out of 2782 initial studies, 51 were included in the review. Most studies used RCT (21) or crossover (23) methodologies with medical residents, students, and attending physicians. Most used post-intervention metrics, while some used pre- and post-intervention metrics. Overall, 34 performance results from studies favored haptics, 3 favored non-haptics, and the rest showed mixed or equal results. CONCLUSION This updated review highlights the diverse application of haptic technology in surgical VSs. Haptics generally enhances performance, complements traditional teaching methods, and offers personalized learning with adequate simulator validation. However, a sparsity of orienting to the simulator, pre-/post-study designs, and small sample sizes poses concerns with the validity of the results. We underscore the urgent need for standardized protocols, large-scale studies, and nuanced understanding of haptic feedback integration. We also accentuate the significance of simulator validation, personalized learning potential, and the need for researcher, educator, and manufacturer collaboration. This review is a guidepost for navigating the complexities and advancements in haptic-enhanced surgical VSs.
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Affiliation(s)
- Sayed Azher
- Department of Surgery, McGill University, Montreal, QC, Canada
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Aralia Mills
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Jinzhi He
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Taliah Hyjazie
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junko Tokuno
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Andrea Quaiattini
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Jason M. Harley
- Department of Surgery, McGill University, Montreal, QC, Canada
- Simulation, Affect, Innovation, Learning, and Surgery (SAILS) Lab, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Knudsen MH, Breindahl N, Dalsgaard TS, Isbye D, Mølbak AG, Tiwald G, Svendsen MBS, Konge L, Bergström J, Todsen T. Using Virtual Reality Head-Mounted Displays to Assess Skills in Emergency Medicine: Validity Study. J Med Internet Res 2023; 25:e45210. [PMID: 37279049 DOI: 10.2196/45210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Many junior doctors must prepare to manage acutely ill patients in the emergency department. The setting is often stressful, and urgent treatment decisions are needed. Overlooking symptoms and making wrong choices may lead to substantial patient morbidity or death, and it is essential to ensure that junior doctors are competent. Virtual reality (VR) software can provide standardized and unbiased assessment, but solid validity evidence is necessary before implementation. OBJECTIVE This study aimed to gather validity evidence for using 360-degree VR videos with integrated multiple-choice questions (MCQs) to assess emergency medicine skills. METHODS Five full-scale emergency medicine scenarios were recorded with a 360-degree video camera, and MCQs were integrated into the scenarios to be played in a head-mounted display. We invited 3 groups of medical students with different experience levels to participate: first- to third-year medical students (novice group), last-year medical students without emergency medicine training (intermediate group), and last-year medical students with completed emergency medicine training (experienced group). Each participant's total test score was calculated based on the number of correct MCQ answers (maximum score of 28), and the groups' mean scores were compared. The participants rated their experienced presence in emergency scenarios using the Igroup Presence Questionnaire (IPQ) and their cognitive workload with the National Aeronautics and Space Administration Task Load Index (NASA-TLX). RESULTS We included 61 medical students from December 2020 to December 2021. The experienced group had significantly higher mean scores than the intermediate group (23 vs 20; P=.04), and the intermediate group had significantly higher scores than the novice group (20 vs 14; P<.001). The contrasting groups' standard-setting method established a pass-or-fail score of 19 points (68% of the maximum possible score of 28). Interscenario reliability was high, with a Cronbach α of 0.82. The participants experienced the VR scenarios with a high degree of presence with an IPQ score of 5.83 (on a scale from 1-7), and the task was shown to be mentally demanding with a NASA-TLX score of 13.30 (on a scale from 1-21). CONCLUSIONS This study provides validity evidence to support using 360-degree VR scenarios to assess emergency medicine skills. The students evaluated the VR experience as mentally demanding with a high degree of presence, suggesting that VR is a promising new technology for emergency medicine skills assessment.
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Affiliation(s)
- Marie Høxbro Knudsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Breindahl
- Prehospital Center Region Zealand, Næstved, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
| | - Tor-Salve Dalsgaard
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Dan Isbye
- Department of Anesthesia, Section 6011, Centre of Head and Orthopeadics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Gerhard Tiwald
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | | | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Joanna Bergström
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Todsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation, Center for HR and Education, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Pedersen H, Ståhl D, Ekelund M, Anderberg M, Bäckström M, Bergenfelz A, Hagelsteen K. Visuospatial ability is associated to 2D laparoscopic simulator performance amongst surgical residents. Surg Open Sci 2022; 11:56-61. [PMID: 36545373 PMCID: PMC9761372 DOI: 10.1016/j.sopen.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/05/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background The technical skills of a surgeon influence surgical outcome. Testing technical aptitude at point of recruitment of surgical residents is only conducted in a few countries. This study investigated the impact of visuospatial ability (VSA), background factors, and manual dexterity on performance in two different laparoscopic surgical simulators amongst applicants and 1st year surgical residents. Method Applicants from general surgery, pediatric surgery, and urology were included from seven hospitals in Sweden between 2017 and 2021. Some 73 applicants were invited and 50 completed. Participants filled out a background form, and were tested for manual dexterity, and visuospatial ability. Two laparoscopic simulators were used, one 2D video box trainer and one 3D Virtual Reality Simulator. Results A significant association was found between the visuospatial ability test and 2D video box laparoscopic performance (95 % CI: 1.028-1.2, p-value <0.01). For every point on the visuospatial test the odds of accomplishing the task increased by 11 %. No association was found between VSA and performance in a laparoscopic VR simulator using 3D vision. No other background factors were associated with performance in the two laparoscopic simulators. Conclusion Visuospatial ability in applicants to surgical residency positions is associated to performance in a 2D video box trainer. Knowledge of a resident's visuospatial ability can be used to tailor individualized laparoscopic training programs, and in the future might function as a selection tool concerning laparoscopic ability. Key message Visuospatial ability differs greatly amongst applicants for surgical residency and is associated to laparoscopic simulator performance. Testing applicants' visuospatial ability could possibly be used to tailor individualized laparoscopic training programs or in the future as a selection tool concerning laparoscopic ability.
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Affiliation(s)
- Hanne Pedersen
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Corresponding author at: Practicum Clinical Skills Centre, Barngatan 2, Skåne University Hospital, SE-221 85 Lund, Sweden.
| | - Darya Ståhl
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
| | - Mikael Ekelund
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Malmö, Sweden
| | - Magnus Anderberg
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Paediatrics, Lund, Sweden
| | - Martin Bäckström
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Psychology, Lund University, Sweden
| | - Anders Bergenfelz
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Lund, Sweden
| | - Kristine Hagelsteen
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Surgery, Lund, Sweden
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Huber M, Katzky U, Müller K, Blätzinger M, Goetz W, Grechenig P, Popp D, Angerpointner K. Evaluation of a New Virtual Reality Concept Teaching K-Wire Drilling With Force Feedback Simulated Haptic in Orthopedic Skills Training. J Hand Surg Am 2022; 47:1225.e1-1225.e7. [PMID: 34857404 DOI: 10.1016/j.jhsa.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/05/2021] [Accepted: 09/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Surgical simulations are becoming increasingly relevant in musculoskeletal training. They provide the opportunity to develop surgical skills in a controlled environment while reducing the risks for patients. For K-wire internal fixation in musculoskeletal surgery, a force feedback virtual reality (VR) simulator was developed. The aim of this study was to evaluate training results using this technology and compare the results with that of standard teaching on cadavers. METHODS Twenty participants attending an AO Trauma Course during 2020 were randomly allocated in 2 groups. On day 1, group A was trained by senior surgeons using a cadaver and group B was trained by the VR simulator for K-wire insertion in the distal radius. On day 2, all participants performed K-wire insertion on the cadaver model, without assistance, to validate the training effect. RESULTS On a surgical skills test, group B performed better than group A. In group B, the entry point of the first K-wire was closer to the targeted styloid process of the radius, and the protrusion of the K-wires into soft tissue was less than that in group A. CONCLUSIONS Training with the VR simulator for K-wire insertion resulted in better surgical skills than training by a surgeon and cadaver model. CLINICAL RELEVANCE Training with the VR simulator provides the opportunity to improve and refine surgical skills without the risk of harming patients. It offers easier access, unlimited repetitions, and is more cost-effective compared with training sessions with cadavers.
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Affiliation(s)
- Michaela Huber
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany.
| | | | - Karolina Müller
- Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | | | - Wolfgang Goetz
- Department of Cardiothoracic-Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Peter Grechenig
- Department of Orthopedics and Traumatology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Daniel Popp
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany
| | - Katharina Angerpointner
- Department of Trauma Surgery & Emergency Department, University Medical Center Regensburg, Regensburg, Germany; Centre for Hand- and Elbow Surgery, Microsurgery and Plastic Surgery, Schoen Clinic München Harlaching, Munich, Germany
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Toale C, Morris M, Kavanagh DO. Perspectives on simulation-based assessment of operative skill in surgical training. MEDICAL TEACHER 2022; 45:1-8. [PMID: 36288727 DOI: 10.1080/0142159x.2022.2134001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The perspectives of the wider surgical community toward simulation-based assessment (SBA) in training is a gap in the literature. This study aims to explore the factors associated with the acceptable use of SBA in surgical training, through the perceptions and experiences of a broad range of stakeholder representatives, building on findings from a review of the published literature. MATERIALS AND METHODS Ten semi-structured interviews were conducted, using a sequential transformative qualitative methods approach, with representatives from identified key stakeholder groups; executive management, risk management, a practicing surgeon, an anaesthesiologist, a theatre-nursing representative, a representative from simulation industry, a patient, a medical student, a junior surgical trainee, and a senior surgical trainee. Interview transcripts underwent reflexive thematic analysis using an inductive and constructivist framework (NVIVO software, NVIVO 12, QSR International). RESULTS Four themes emerged: the 'need' for SBA, the concept of a 'minimum standard', the 'optimum design' of an SBA framework, and 'fairness'. SBA is a potential solution to challenges in the current training environment. It emerged that it should not replace trainer judgement, but could ensure that trainees meet a minimum operative competency standard. SBA should be used to identify underperforming trainees early in training to provide targeted remediation. The application of SBA in high-stakes settings such as trainee selection, autonomy granting, and end-of training certification has perceived benefits over current assessment methods. CONCLUSIONS This study builds on findings from prior research to explore factors regarding the acceptable use of simulation as an assessment method in surgical training, including perspectives from a broad range of stakeholder representatives. Findings can inform the development of simulation-based assessment curricula in surgical training.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Jiang H, Vimalesvaran S, Wang JK, Lim KB, Mogali SR, Car LT. Virtual Reality in Medical Students' Education: Scoping Review. JMIR MEDICAL EDUCATION 2022; 8:e34860. [PMID: 35107421 PMCID: PMC8851326 DOI: 10.2196/34860] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. OBJECTIVE The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. METHODS We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. CONCLUSIONS Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-046986.
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Affiliation(s)
- Haowen Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jeremy King Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Kee Boon Lim
- School of Biological Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | | | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Melo M, Goncalves G, Monteiro P, Coelho H, Vasconcelos-Raposo J, Bessa M. Do Multisensory Stimuli Benefit the Virtual Reality Experience? A Systematic Review. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:1428-1442. [PMID: 32746276 DOI: 10.1109/tvcg.2020.3010088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The majority of virtual reality (VR) applications rely on audiovisual stimuli and do not exploit the addition of other sensory cues that could increase the potential of VR. This systematic review surveys the existing literature on multisensory VR and the impact of haptic, olfactory, and taste cues over audiovisual VR. The goal is to identify the extent to which multisensory stimuli affect the VR experience, which stimuli are used in multisensory VR, the type of VR setups used, and the application fields covered. An analysis of the 105 studies that met the eligibility criteria revealed that 84.8 percent of the studies show a positive impact of multisensory VR experiences. Haptics is the most commonly used stimulus in multisensory VR systems (86.6 percent). Non-immersive and immersive VR setups are preferred over semi-immersive setups. Regarding the application fields, a considerable part was adopted by health professionals and science and engineering professionals. We further conclude that smell and taste are still underexplored, and they can bring significant value to VR applications. More research is recommended on how to synthesize and deliver these stimuli, which still require complex and costly apparatus be integrated into the VR experience in a controlled and straightforward manner.
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Pallavicini F, Pepe A, Clerici M, Mantovani F. Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review (Preprint). JMIR Serious Games 2021; 10:e35000. [PMID: 36282554 PMCID: PMC9605086 DOI: 10.2196/35000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/18/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis. Methods We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/
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Affiliation(s)
- Federica Pallavicini
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Alessandro Pepe
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Fabrizia Mantovani
- Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Milano, Italy
- Gamers VR Lab, Università degli Studi di Milano-Bicocca, Milano, Italy
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Comparative Analysis of Three-Versus Two-dimensional Imaging in Laparoscopic Cholecystectomy. World J Surg 2021; 45:1370-1375. [PMID: 33475802 DOI: 10.1007/s00268-020-05934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging has been suggested to improve learning and performance of laparoscopy. We sought to investigate whether 3D imaging could improve the outcomes after laparoscopic cholecystectomy. MATERIALS AND METHODS Two-hundred and forty-one consecutive patients underwent elective or urgent laparoscopic cholecystectomy using 2D (n = 111) and 3D (n = 130) imaging equipments from March 2017 to March 2019 at the Kainuu Central Hospital, Finland. The main outcomes of this study were biliary tract injury, conversion to open procedure and procedure duration. RESULTS In the overall series, there were 5 cases of biliary tract injury (2.1%). When compared to 3D imaging, 2D was associated with increased risk of biliary tract injury in the overall series (0% in 3D vs. 4.7% in 2D, p = 0.026) in addition to a subgroup of acute cholecystitis patients operated by senior surgeons (n = 92), 0% in 3D group (n = 60) vs. 10.0% in 2D group (n = 32), p = 0.037 in univariate analysis. The rates of conversion to open surgery did not differ between the groups in the overall series (5.3 vs 5.7%, p = 0.909) or any of the subgroups. Duration of surgery with 3D vs. 2D imaging were comparable in the elective (57.0 ± 16.3 vs. 54.1 ± 18.9 min, p = 0.228) and urgent setting (66.9 ± 15.1 vs. 67.4 ± 16.6 min, p = 0.805). Such differences were not significant in multivariate analysis. CONCLUSIONS The present study suggests that the use of 3D imaging is significantly associated with a reduced risk of intraoperative biliary tract injury during laparoscopic cholecystectomy especially in acute cholecystitis.
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Zwimpfer TA, Lacher D, Fellmann-Fischer B, Mueller M. A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students. BMC Surg 2020; 20:276. [PMID: 33167972 PMCID: PMC7650199 DOI: 10.1186/s12893-020-00892-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vision is an essential element of laparoscopic surgery that defines the outcome of an operation in regards to time, mistakes and precision. A 3-dimensional (3D) perspective may improve vision during an operation. Therefore, this study was designed to compare 3D versus 2-dimensional (2D) perspectives using a pelvitrainer model. METHODS Fifty candidates were divided into 3 categories based on different experience levels. The candidates were randomised into two groups, with each group performing the same 4 standardised tasks. Group A approached the tasks first with 3D high definition and in a second turn with 2D high definition. Group B carried out the tasks with the systems in reverse order. Task completion time and the number of mistakes made for each task were recorded. After completing the tasks, participants answered questions concerning the two systems. RESULTS Group A was, on average, 20% faster at all four tasks and made approximately 18% fewer mistakes in two of the tasks in comparison to group B. The experts significantly benefited from the 3D system in terms of accuracy compared to non-experts and students. The students demonstrated a significantly greater benefit from the 3D system when performing non-linear, continuous movements. Loss of concentration occurred at the same rate for subjects using the 2D and 3D systems. Nausea and dizziness were reported only when working with the 3D system. 91% found the 3D system advantageous for accomplishing the tasks. CONCLUSIONS Irrespective of experience level, 3D laparoscopy shows advantages in saving time, increasing accuracy and reducing mistakes. These benefits were also accompanied by subjective advantages that were noted by the participants. However, the more complex the task, the less significant the benefit of the 3D system and some people feel handicapped by the eyewear.
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Affiliation(s)
| | | | | | - Michael Mueller
- University Hospital Berne, Gynecological Clinic, Berne, Switzerland
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De Ponti R, Marazzato J, Maresca AM, Rovera F, Carcano G, Ferrario MM. Pre-graduation medical training including virtual reality during COVID-19 pandemic: a report on students' perception. BMC MEDICAL EDUCATION 2020; 20:332. [PMID: 32977781 PMCID: PMC7517753 DOI: 10.1186/s12909-020-02245-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/16/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The Coronavirus Disease 19 (COVID-19) pandemic brought significant disruption to in-hospital medical training. Virtual reality simulating the clinical environment has the potential to overcome this issue and can be particularly useful to supplement the traditional in-hospital medical training during the COVID-19 pandemic, when hospital access is banned for medical students. The aim of this study was to assess medical students' perception on fully online training including simulated clinical scenarios during COVID-19 pandemic. METHODS From May to July 2020 when in-hospital training was not possible, 122 students attending the sixth year of the course of Medicine and Surgery underwent online training sessions including an online platform with simulated clinical scenarios (Body Interact™) of 21 patient-based cases. Each session focused on one case, lasted 2 h and was divided into three different parts: introduction, virtual patient-based training, and debriefing. In the same period, adjunctive online training with formal presentation and discussion of clinical cases was also given. At the completion of training, a survey was performed, and students filled in a 12-item anonymous questionnaire on a voluntary basis to rate the training quality. Results were reported as percentages or with numeric ratings from 1 to 4. Due to the study design, no sample size was calculated. RESULTS One hundred and fifteen students (94%) completed the questionnaire: 104 (90%) gave positive evaluation to virtual reality training and 107 (93%) appreciated the format in which online training was structured. The majority of participants considered the platform of virtual reality training realistic for the initial clinical assessment (77%), diagnostic activity (94%), and treatment options (81%). Furthermore, 97 (84%) considered the future use of this virtual reality training useful in addition to the apprenticeship at patient's bedside. Finally, 32 (28%) participants found the online access difficult due to technical issues. CONCLUSIONS During the COVID-19 pandemic, online medical training including simulated clinical scenarios avoided training interruption and the majority of participant students gave a positive response on the perceived quality of this training modality. During this time frame, a non-negligible proportion of students experienced difficulties in online access to this virtual reality platform.
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Affiliation(s)
- Roberto De Ponti
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy.
| | - Jacopo Marazzato
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
| | - Andrea M Maresca
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
| | - Francesca Rovera
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
| | - Marco M Ferrario
- Department of Medicine and Surgery, School of Medicine, University of Insubria, Viale Borri, 57, 21100, Varese, Italy
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12
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Zhang B, Li S, Gao S, Hou M, Chen H, He L, Li Y, Guo Y, Wang E, Cao R, Cheng J, Li R, Zhang K. Virtual versus jaw simulation in Oral implant education: a randomized controlled trial. BMC MEDICAL EDUCATION 2020; 20:272. [PMID: 32811485 PMCID: PMC7433198 DOI: 10.1186/s12909-020-02152-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/15/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND This research aims to investigate the evaluation methods of teaching oral implant clinical courses and estimate the effectiveness of a virtual simulation platform. METHODS Eighty second- and third-year undergraduates in Lanzhou University were recruited and randomized to either three experimental groups or one control group. The subjects undertook theoretical examinations to test their basic level of knowledge after training in similarly unified knowledge courses. Each student group then participated in an eight-hour operating training session. An operation test on pig mandible was conducted, followed by a second theoretical examination. The assessment consists of three distinct parts: a subjective operating score by a clinical senior teacher, an implant accuracy analysis in cone-beam computed tomography (angular, apical, and entrance deviation), and comparison of the two theoretical examinations. Finally, students completed a questionnaire gauging their understanding of the virtual simulation. RESULTS There was no significant difference between the four groups in first theoretical examination (P > 0.05); the second theoretical scores of the V-J and J-V group (62.90 ± 3.70, 60.05 ± 2.73) were significantly higher than the first time (57.05 ± 3.92, P < 0.05), while no difference between the V (57.10 ± 3.66) and J (56.89 ± 2.67) groups was found. Thus, the combination of V-J was effective in improving students' theoretical scores. The V-J and J-V groups had higher scores on operation (73.98 ± 4.58, 71.85 ± 4.67) and showed better implant precision. CONCLUSION Virtual simulation education, especially with a jaw simulation model, could improve students' implantology achievements and training. Currently study found that the V-J group may performed better than the J-V group in oral implant teaching.
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Affiliation(s)
- Baoping Zhang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Sihong Li
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Shuting Gao
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Mingfang Hou
- College of Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Hong Chen
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Lulu He
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Yiting Li
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Yumeng Guo
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Errui Wang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Rui Cao
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Jingyang Cheng
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Ruiping Li
- School of Stomatology Lanzhou University, Lanzhou, 730000, China
| | - Kailiang Zhang
- School of Stomatology Lanzhou University, Lanzhou, 730000, China.
- Hospital of Stomatology, Lanzhou University, Lanzhou, 730000, China.
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Okuda Y, Nakai A, Sato T, Kurata M, Shimoyama I, Oda T, Ohkohci N. New device with force sensors for laparoscopic liver resection - investigation of grip force and histological damage. MINIM INVASIV THER 2020; 31:28-33. [PMID: 32468887 DOI: 10.1080/13645706.2020.1755313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: As the benefits of minimally invasive surgery are recognized, the rate of laparoscopic liver resection (LLR) is rapidly increasing. Liver tissue is fragile compared to tissue of the stomach and colon. In endoscopic and robotic surgery, sufficient tactile sensation is yet to be obtained. Therefore, it is necessary to measure and indicate the grip force of forceps during surgery. We developed a new device consisting of force sensors and investigated its grip force and the resulting histological damage to liver tissue.Material and methods: We measured the grip force generated during laparoscopic surgery in pigs using the forceps with pressure sensors developed by us. Throughout the hepatectomy, we measured the grip force generated by the forceps in real time. We investigated the histological damage to the liver caused by using the forceps with different grip forces.Results: The subject produced a mean grip force of 1.75 N during the procedures. The maximum grip force was 3.38 N. By grasping the tissues of the liver with forceps, bleeding and destruction of the hepatic lobules were observed in a manner dependent on increasing grip force.Conclusion: The new device is necessary for preventing liver damage in laparoscopic hepatic resection.
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Affiliation(s)
- Yoichi Okuda
- Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba, Japan.,Mito Chuo Hospital, Mito, Japan
| | - Akihito Nakai
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, University of Tokyo, Tokyo, Japan
| | - Taiki Sato
- Department of Pathology, Faculty of Medicine, Diagnostic Pathology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masano Kurata
- Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba, Japan
| | - Isao Shimoyama
- Department of Mechano-Informatics, Graduate School of Information Science and Technology, University of Tokyo, Tokyo, Japan
| | - Tatsuya Oda
- Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba, Japan
| | - Nobhuhiro Ohkohci
- Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery, and Organ Transplantation, University of Tsukuba, Tsukuba, Japan.,Mito Chuo Hospital, Mito, Japan
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Rangarajan K, Davis H, Pucher PH. Systematic Review of Virtual Haptics in Surgical Simulation: A Valid Educational Tool? JOURNAL OF SURGICAL EDUCATION 2020; 77:337-347. [PMID: 31564519 DOI: 10.1016/j.jsurg.2019.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/02/2019] [Accepted: 09/08/2019] [Indexed: 05/25/2023]
Abstract
BACKGROUND Virtual reality (VR)-based surgical simulation is an expanding and rapidly advancing modality which aims to serve the increasing demand to acquire surgical skills outside the live operating room. Haptic, or "force-feedback" technology in VR simulation is a rapidly developing field, however the role of haptics in surgical education and its efficacy is unclear. METHODS A systematic literature search was carried out until September 2018 in MEDLINE, Embase, and Cochrane Library using the following keywords: (VR OR VR OR simulation OR simulator) AND (Haptic feedback OR Haptics OR Force feedback) AND (Surgery). All randomized controlled studies comparing VR training with and without haptics were included. PRISMA guidelines were adhered to RESULTS: Eight randomized controlled trials that compare VR training with and without haptics were included and 1 survey study with a total of 215 participants, 116 of which received haptic feedback and 99 were assigned to nonhaptic feedback group. Training tasks included basic proficiency based laparoscopic tasks such as object translocation, cutting, camera navigation, and more complex tasks including diathermy, suturing, dissection, knot tying, and operative maneuvers. Six randomized controlled trials demonstrated that haptic enhanced VR simulation is significantly more effective than without haptics for skill training with a reduced learning curve and faster time to proficiency and task completion, particularly in novice learners. Two studies showed no significant differences in task-assessed parameters between the haptics and nonhaptics cohorts, whereas 1 survey study suggested haptics negatively affected training with decreased realism. CONCLUSION Haptic feedback has been shown to improve the fidelity, realism and thus the training effect of VR simulators. However, at present haptic simulators are expensive and in a nascent stage and further research as well as cost-benefit analyses of such tools must be considered to determine whether haptics is truly a surgical necessity.
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Affiliation(s)
- Karan Rangarajan
- Department of Surgery, Frimley Park Hospital NHS FT, Camberley, United Kingdom.
| | - Heather Davis
- Department of Surgery, Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Philip H Pucher
- Department of Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom; Department of Surgery, St Mary's Hospital, Imperial College London, London, United Kingdom
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Våpenstad C, Fagertun Hofstad E, Eivind Bernstein T, Aadahl P, Johnsen G, Mårvik R. Optimal timing of assessment tasks depending on experience level of surgical trainees. MINIM INVASIV THER 2019; 29:161-169. [DOI: 10.1080/13645706.2019.1612441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Health Research, SINTEF Digital AS, Trondheim, Norway
| | | | - Tor Eivind Bernstein
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Aadahl
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gjermund Johnsen
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Hagelsteen K, Johansson R, Ekelund M, Bergenfelz A, Anderberg M. Performance and perception of haptic feedback in a laparoscopic 3D virtual reality simulator. MINIM INVASIV THER 2019; 28:309-316. [DOI: 10.1080/13645706.2018.1539012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kristine Hagelsteen
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Richard Johansson
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
| | - Mikael Ekelund
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Anders Bergenfelz
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Magnus Anderberg
- Practicum Clinical Skills Centre, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
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17
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Bugdadi A, Sawaya R, Bajunaid K, Olwi D, Winkler-Schwartz A, Ledwos N, Marwa I, Alsideiri G, Sabbagh AJ, Alotaibi FE, Al-Zhrani G, Maestro RD. Is Virtual Reality Surgical Performance Influenced by Force Feedback Device Utilized? JOURNAL OF SURGICAL EDUCATION 2019; 76:262-273. [PMID: 30072262 DOI: 10.1016/j.jsurg.2018.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/19/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The study objectives were to assess if surgical performance and subjective assessment of a virtual reality simulator platform was influenced by changing force feedback devices. DESIGN Participants used the NeuroVR (formerly NeuroTouch) simulator to perform 5 practice scenarios and a realistic scenario involving subpial resection of a virtual reality brain tumor with simulated bleeding. The influence of force feedback was assessed by utilizing the Omni and Entact haptic systems. Tier 1, tier 2, and tier 2 advanced metrics were used to compare results. Operator subjective assessment of the haptic systems tested utilized seven Likert criteria (score 1 to 5). SETTING The study is carried out at the McGill Neurosurgical Simulation Research and Training Centre, Montreal Neurological Institute and Hospital, Montreal, Canada. PARTICIPANTS Six expert operators in the utilization of the NeuroVR simulator platform. RESULTS No significant differences in surgical performance were found between the two haptic devices. Participants significantly preferred the Entact system on all 7 Likert criteria of subjective assessment. CONCLUSIONS Our results show no statistical differences in virtual reality surgical performance utilizing the two bimanual haptic devices tested. Subjective assessments demonstrated that participants preferred the Entact system. Our results suggest that to maximize realism of the training experience educators employing virtual reality simulators may find it useful to assess expert opinion before choosing a force feedback device.
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Affiliation(s)
- Abdulgadir Bugdadi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah Almukarramah, Saudi Arabia.
| | - Robin Sawaya
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Khalid Bajunaid
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Duaa Olwi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ibrahim Marwa
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
| | - Ghusn Alsideiri
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Department of Surgery, College of Medicine, Sultan Qaboos University, Muscat, Oman
| | - Abdulrahman Jafar Sabbagh
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Clinical Skill and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad E Alotaibi
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gmaan Al-Zhrani
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada; National Neuroscience Institute, Department of Neurosurgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rolando Del Maestro
- Neurosurgical Simulation Research and Training Centre, Department of Neurosurgery and Neurology, McGill University, Montreal, Quebec, Canada
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Mazur T, Mansour TR, Mugge L, Medhkour A. Virtual Reality–Based Simulators for Cranial Tumor Surgery: A Systematic Review. World Neurosurg 2018; 110:414-422. [DOI: 10.1016/j.wneu.2017.11.132] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/19/2017] [Accepted: 11/22/2017] [Indexed: 01/22/2023]
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