Virtual phacoemulsification surgical simulation using visual guidance and performance parameters as a feasible proficiency assessment tool

Abstract

BackgroundComputer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters.MethodsTen experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures – 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator.ResultsSubjects with greater experience obtained significantly higher scores in all four main procedures – CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules – CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor – C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture – CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077).ConclusionsStatistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters.

Intraoperative head drift and eye movement: two under addressed challenges during cataract surgery

“…This concept was corroborated by two of our trainees having radial extensions of their CCC when eye movements were introduced. Several studies have shown improved performance of junior ophthalmologists in the operating room after practicing on the Eyesi [12][13][14][15][16][17][18][19][20][21][22]; in particular, the rates of errant CCC are significantly reduced [17, 19,]. One of the limitations of the Eyesi in preparing trainees for real cataract surgery, however, is lack of intraoperative eye movement during the exercises.…”

The Utility of Virtual Reality Simulation in Cataract Surgery Training: A Systematic Review

“…Most compared computed module performance across first-time operators and found expert/intermediate surgeons to outperform novices. [26][27][28][29][30][31][32][33] Banerjee et al found simulator scores to correlate with prior live surgical performance, 34 while others described similar associations with additional stratification by experience level. 35,36 Meanwhile, Sikder et al endorsed improvement in capsulorhexis scores from baseline after 6 months of residency training.…”

Use of virtual reality simulation in surgical training: a systematic review on predictive validity and current use in surgical curricula

“…A potential advantage of simulation training is its ability to correctly identify the relative skill and experience level of the user, which may also be useful in delineating the relative safety of the surgical trainees. 50,51 Four studies 20,35,41,42 in this review looked at transfer of skills to animal tissue from VR alone, with mixed findings. Feudner et al 20 noted an increase in proficiency across several parameters using porcine substitutes, which would indicate the transfer of simulated skills to biological tissue.…”