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Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study

Seymour, Neal E. MD*; Gallagher, Anthony G. PhD; Roman, Sanziana A. MD*; O’Brien, Michael K. MD*; Bansal, Vipin K. MD*; Andersen, Dana K. MD*; Satava, Richard M. MD*

Scientific Papers Of The American Surgical Association

Objective To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment.

Summary Background Data The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study.

Methods Sixteen surgical residents (PGY 1–4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80).

Results No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P < .007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P < .04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case;P < .008, Mann-Whitney test).

Conclusions The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

From the *Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, U.S.A., and the †Department of Psychology, Queens University, Belfast, Northern Ireland, U.K.

Supported with a grant from the Fulbright Distinguished Scholar Program (A.G.G.).

Presented at the 122nd Annual Meeting of the American Surgical Association, April 24–27, 2002, The Homestead, Hot Springs, Virginia.

Correspondence: Neal E. Seymour, MD, Department of Surgery, Yale University School of Medicine, TMP 202, 330 Cedar Street, New Haven, CT 06520-8062.

E-mail: neal.seymour@yale.edu

Accepted for publication April 24, 2002.

© 2002 Lippincott Williams & Wilkins, Inc.