Warm-up in a virtual reality environment improves performance in the operating room.

OBJECTIVE: To assess the impact of warm-up on laparoscopic performance in the operating room (OR). BACKGROUND: Implementation of simulation-based training into clinical practice remains limited despite evidence to show that the improvement in skills is transferred to the OR. The aim of this study was to evaluate the impact of a short virtual reality warm-up training program on laparoscopic performance in the OP. METHODS: Sixteen Laparoscopic Cholecystectomies were performed by 8 surgeons in the OR. Participants were randomized to a group which received a preprocedure warm-up using a virtual reality simulator and no warm-up group. After the initial laparoscopic cholecystectomy all surgeons served as their own controls by performing another procedure with or without preoperative warm-up. All OR procedures were videotaped and assessed by 2 independent observers using the generic OSATS global rating scale (from 7 to 35). RESULTS: There was significantly better surgical performance on the laparoscopic Cholecystectomy following preoperative warm-up, median 28.5 (range = 18.5-32.0) versus median 19.25 (range = 15-31.5), P = 0.042. The results demonstrated excellent reliability of the assessment tool used (Cronbach's alpha = 0.92). CONCLUSION: This study showed a significant beneficial impact of warm-up on laparoscopic performance in the OP. The suggested program is short, easy to perform, and therefore realistic to implement in the daily life in a busy surgical department. This will potentially improve the procedural outcome and contribute to improved patient safety and better utilization of OR resources.

The impact of constructive feedback on training in gastrointestinal endoscopy using high-fidelity Virtual-Reality simulation: a randomised controlled trial.

BACKGROUND: Recently, virtual reality computer simulators have been used to enhance traditional endoscopy teaching. Previous studies have demonstrated construct validity of these systems and transfer of virtual skills to the operating room. However, to date no simulator-training curricula have been designed and there is very little evidence on the impact of external feedback on acquisition of endoscopic skills. The aim of the present study was to assess the impact of external feedback on the learning curves on a VR colonoscopy simulator using inexperienced trainees. MATERIALS AND METHODS: 22 trainees, without colonoscopy experience were randomised to a group which received structured feedback provided by an experienced supervisor and a controlled group. All participants performed 15 repetitions of task 3 from the Introduction colonoscopy module of the Accu Touch Endoscopy simulator. Retention/transfer tests on simulator were performed 4-6 weeks after the last repetition. The proficiency levels were based on the performance of eight experienced colonoscopists. RESULTS: All subjects were able to complete the procedure on the simulator. There were no perforations in the feedback group versus seven in the non-feedback group. Subjects in the feedback group reached expert proficiency levels in percentage of mucosa visualised and time to reach the caecum significantly faster compared with the control group. None of the groups demonstrated significant degradation of performance in simulator retention/transfer tests. CONCLUSION: Concurrent feedback given by supervisor concur an advantage in acquisition of basic colonoscopy skills and achieving of proficiency level as compared to independent training.

Assessment of early learning curves among nurses and physicians using a high-fidelity virtual-reality colonoscopy simulator.

BACKGROUND: Recently, it has been suggested that nurses can perform diagnostic endoscopy procedures, which traditionally have been a physician's responsibility. The existing studies concerning quality of sigmoidoscopy performed by nurses are small, used assessment tools with insufficient validation and to date there is very little knowledge of the learning curve patterns for physicians and nurses. The aim of a present study was to assess early learning curves on a virtual-reality colonoscopy simulator of untrained residents as compared with that of nurses with and without endoscopy assistance experience. MATERIALS AND METHODS: Thirty subjects were included in the study: 10 female residents (median age 30.5 years) without colonoscopy experience, 10 female nurses (median age 27.5 years) without endoscopy assistance experience and 10 female nurses (median age 42 years) with endoscopy assistance experience. All participants performed 10 repetitions of task 6 from the "Introduction" colonoscopy module of the Accu Touch Endoscopy simulator. Eight experienced colonoscopists performed three repetitions of task 6 in order to provide the reference expert level of performance. RESULTS: All subjects completed the virtual colonoscopy without complications. Significant differences existed between residents and nurses with respect to time to complete the procedure. Residents and nurses showed similar learning curve patterns. There were not significant differences between the groups in terms of volume of insufflated air, percentage of time without discomfort, and percentage of mucosa seen. None of the trainee groups achieved expert proficiency level in terms of time and amount of insufflated air by the tenth repetition. CONCLUSIONS: Nurses performed virtual colonoscopy as accurately and safely as residents. Although the residents performed significantly faster, time differences showed a tendency towards decreasing, and appraisement of the numeric time differences seemed of minor practical importance. From a technical point of view this indicates that nurses may learn to perform colonoscopy after appropriate training.