Do Experts Give Better Feedback Than Novices on Virtual Reality Simulators?

Dmitry Nepomnayshy, MD, Lilian Chen, MD, Kuhn Jay, MD, Ron Bush, BS, MIS, Neal Seymour, MD

Lahey Clinic Medical Center, Baystate Medical Center

INTRODUCTION: Surgical simulator technology is rapidly evolving and expert surgeon advice is often sought in development and testing. Haptic-enabled Virtual Reality (HVR) simulation has potential advantages over box trainers; however, suturing has been traditionally regarded as a weakness due to the requirement for high fidelity and complex nature of the task. Traditionally, suturing task expertise and prior simulator experience would be required to provide reliable feedback. We wanted to assess if surgeons’ perception of HVR suturing was related to their skill and experience level.

METHODS: All subjects completed a self-assessment questionnaire and then performed a suturing task on the LapVRTM surgical simulator in the Learning Center at the SAGES 2012 annual meeting. Their perception of specific aspects of the simulation were recorded and analyzed in relation to their experience and actual skill level. Data was analyzed using the non-parametric Wilcoxon rank-sum test.

RESULTS: Out of 54 surgeons, 44% had prior virtual reality (VR) simulator experience, 47% were attending surgeons and 46% self-assessed themselves as experienced. Those that actually performed well on the simulator were more likely to self-assess themselves as experienced 64% (14/22) vs those that didn’t 34% (11/32) p=0.0341. Using a 5 point Likert scale, the median response was 3 for most categories of realism and quality of haptic feedback, even though “object realism” was 4 and “this simulators’ ability to improve actual clinical performance” was 3.5. There was no difference between any of the groups in how they perceived the simulator, with the exception that experienced surgeons were more likely to assess “thread behavior as appropriate” compared to inexperienced surgeons (p=0.037)

CONCLUSIONS: Surgeons’ experience and ability did not affect their perception of suturing fidelity on a haptic enabled virtual reality simulator. Surgeons can provide accurate feedback on VR simulator tasks even though they may be inexperienced, unfamiliar with the simulator, or unable to perform the simulated task. Surgeons are able to accurately self-assess their laparoscopic skill.