Subject(s)
Bariatrics , COVID-19 , Obesity, Morbid , Humans , Obesity, Morbid/surgery , Pandemics , SARS-CoV-2ABSTRACT
Background: The COVID-19 pandemic has restricted our ability to gather and train together. High-fidelity simulation platforms have been developed that merge virtual-reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual-reality (MVR) platform for instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills. Methods: This was a prospective randomized controlled noninferiority study. Thirty participants were randomized among 3 groups to detect a noninferiority margin set at 10% of the mean improvement in expected total FLS scores. Group 1 received "standard" in-person expert instruction. Group 2 received similar training administered via the MVR platform. Group 3 (control) practised on their own, with no feedback. All participants were tested for baseline performance, then immediately after training, and 1 month later. Groups were compared using ordinary 1-way analysis of variance. Results: MVR was noninferior to the standard in-person training group for total FLS times on both immediate (p = 0.632) and delayed post-testing (p = 0.829). Performance was also identical between MVR and standard training groups for each FLS task. All 3 groups improved from baseline after training. Greater improvements were observed in the standard and MVR arms than in controls for all tasks except for peg transfer and pattern cut, which did not reach statistical significance. Conclusion: This randomized controlled trial provides validity evidence for the use of an MVR platform as a noninferior alternative to in-person instruction for initial FLS instruction, forming the foundation for future work on remote training and collaboration.
ABSTRACT
BACKGROUND: The COVID-19 pandemic challenges our ability to provide surgical education, as our ability to gather and train together has been restricted due to safety concerns. However, the importance of quality surgical education has remained. High-fidelity simulation platforms have been developed that merge virtual reality video streams to allow for remote instruction and collaboration. This study sought to validate the use of a merged virtual reality (MVR) platform for the instruction and assessment of the fundamentals of laparoscopic surgery (FLS) skills. METHODS: This was a prospective randomized controlled non-inferiority study. Thirty participants were randomized between three groups: The standard group received in-person instruction and expert feedback, the experimental group received identical training via the MVR platform, and the control group practiced on their own, but received no feedback. All participants were pre-tested for baseline performance at the beginning of the study. Change in performance was evaluated immediately after training and one month later for retention. Ordinary one-way analysis of variance was used to evaluate the effects of time, group, and time-on-group. RESULTS: The pre-test confirmed baseline homogeneity between the groups. MVR was non-inferior to standard in-person training for total FLS times on either the post-test (p = 0.632) or the retention test (p = 0.829). Performance was also identical between MVR and standard training groups for each of the individual FLS tasks. Each group improved significantly in nearly all tasks after practice; however, the standard and MVR training groups both improved significantly more than controls for the ligating loop, extracorporeal suturing, intracorporeal suturing, and total FLS task training but did not reach statistical significance for peg transfer and pattern cut tasks. CONCLUSION: This randomized, controlled trial has demonstrated the use of an MVR platform as non-inferior to in-person instruction for the FLS program, forming the foundation for future work on remote instruction and collaboration.