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01-03-2016

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

Authors: Ganesh Sankaranarayanan, Baichun Li, Kelly Manser, Stephanie B. Jones, Daniel B. Jones, Steven Schwaitzberg, Caroline G. L. Cao, Suvranu De

Published in: Surgical Endoscopy | Issue 3/2016

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.

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):964–967CrossRefPubMed

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.PubMedCentralCrossRefPubMed

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):401–405CrossRefPubMed

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

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

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):2171–2177CrossRefPubMed

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):658–665CrossRefPubMed

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

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

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):271–370CrossRefPubMed

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.PubMedCentralCrossRefPubMed

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

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):2856–2862PubMedCentralCrossRefPubMed

15.

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

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):380–386CrossRefPubMed

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):902–907PubMedCentralCrossRefPubMed

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):437–443PubMedCentralCrossRefPubMed

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):107–113CrossRefPubMed

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):1347–1352CrossRefPubMed

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):2416–2420CrossRefPubMed

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) CrossRefPubMed

23.

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

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):306–311CrossRefPubMed

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):94–98CrossRef

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):196–201CrossRefPubMed

27.

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

Authors: Ganesh Sankaranarayanan
Baichun Li
Kelly Manser
Stephanie B. Jones
Daniel B. Jones
Steven Schwaitzberg
Caroline G. L. Cao
Suvranu De
Publication date: 01-03-2016
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-015-4278-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods and procedures

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods and procedures

Results

Conclusion

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