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Aim This study aimed to assess if multiplayer virtual reality training was superior to single player training for acquisition of both technical and non-technical skills in learning complex open surgery. Method 40 participants (20 novice surgeons and 20 novice scrub nurses) were enrolled in this study and randomised to solo or team virtual reality training learning anterior approach total hip arthroplasty. Solo participants trained with virtual avatar counterparts, whilst teams trained in pairs (surgeon and scrub nurse). Both groups underwent 5 VR training sessions over 6 weeks. Subsequently, they underwent a real-life assessment in which they performed AA-THA on a high-fidelity model with real equipment in a simulated operating theatre. Teams performed together and solo participants were randomly paired up with a solo player of the opposite role. Videos of the assessment were marked by two blinded expert assessors. The primary outcome was team performance as graded by the NOTECHs II score. Secondary outcomes were procedure time, technical errors from an expert pre-defined protocol and acetabular component positioning. Results Teams outperformed solo trained participants in non-technical skills in the real-world assessment (NOTECHS-II score 50.3 ± 6.04 vs 43.90 ± 5.90, p=0.0275). They completed the assessment 28.11% faster than solos (31.22 minutes ±2.02 vs 43.43 ±2.71, p=0.01), and made close to half the number of technical errors when compared to the solo group (12.9 ± 8.3 vs 25.6 ± 6.1, p=0.001). Conclusions Multiplayer training appears to lead to faster surgery with fewer technical errors and the development of superior non-technical skills.

Aim Rectal cancer treatment has improved over the years, but variations in practice remain. Abdominoperineal resection (APER) is associated with significant morbidity and pre-operative radiotherapy (RT) is only recommended for advanced rectal cancer. As such, APER and RT should be reserved for patients with an appropriate clinical need. The aim of the study is to evaluate the association between the rates of APER and RT, and whether any other factors are associated. Method Data on rectal cancer cases was extracted from National Bowel Cancer Audit 2019. Primary outcomes were: APER rate, RT rate. Pearson’s correlation coefficient was calculated. The means for APER and pre-operative radiotherapy were plotted on a four-quadrant matrix. The differences were analysed using Mann-Whitney U and Student T-test. Results 3,764 patients were included. A mean of 25% (95%CI: 10.3-14.9%) underwent APER and an average of 34% (95%CI: 30.5-36.8%) received RT. There was a weak positive correlation between rates of APER and RT (r = 0.356, p < 0.001). 43 (37%) trusts had proportions of both APER and RT below the overall mean, whilst 30 (26%) had both proportions above. No significant differences were found when comparing other variables between the high to low-rate trusts (p > 0.05). Conclusions There is a weak positive correlation between the proportion of rectal cancer patients undergoing APER and the proportion receiving RT in trusts across England and Wales. It is unknown whether this finding has a clinical significance and further analysis on trust/surgeon performance and patient demographics is needed, allowing for prevention strategies to be implemented.

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