Virtual reality training for surgical trainees in laparoscopic surgery

 

Abstract

Background

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training.

Objectives

To determine whether virtual reality training can supplement or replace conventional laparoscopic surgical training (apprenticeship) in surgical trainees with limited or no prior laparoscopic experience.

Search methods

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and grey literature until March 2008.

Selection criteria

We included all randomised clinical trials comparing virtual reality training versus other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training.

Data collection and analysis

We collected the data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, conversion rate, operating time, and hospital stay. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the standardised mean difference with 95% confidence intervals based on intention-to-treat analysis.

Main results

We included 23 trials with 612 participants. Four trials compared virtual reality versus video trainer training. Twelve trials compared virtual reality versus no training or standard laparoscopic training. Four trials compared virtual reality, video trainer training and no training, or standard laparoscopic training. Three trials compared different methods of virtual reality training. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors compared with no training; virtual reality group was more accurate than video trainer training group. In the participants with limited laparoscopic experience, virtual reality training reduces operating time and error better than standard in the laparoscopic training group; composite operative performance score was better in the virtual reality group than in the video trainer group.

Authors' conclusions

Virtual reality training can supplement standard laparoscopic surgical training of apprenticeship and is at least as effective as video trainer training in supplementing standard laparoscopic training. Further research of better methodological quality and more patient-relevant outcomes are needed.

 

Plain language summary

Virtual reality training can supplement standard surgical training

Surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform the surgery under the supervision of a trained surgeon. This is costly, time consuming, and is of variable effectiveness. Training using virtual reality simulator (a computer simulator) is an option to supplement standard training. We included all randomised clinical trials comparing virtual reality training and other forms of training including video trainer training, no training, or standard laparoscopic training in surgical trainees with little or no prior laparoscopic experience. We also included trials comparing different methods of virtual reality training. A total of 23 trials involving 612 participants were included. Most of the trials were of high risk of bias. In trainees without prior surgical experience, virtual reality training decreased the time taken to complete a task, increased accuracy, and decreased errors better than in the no training group. In the same participant group, virtual reality group was more accurate than video trainer training. In the participants with limited laparoscopic experience, virtual reality training reduced operating time, improved accuracy and decreased unnecessary movements better than standard laparoscopic training. In this participant group, the composite operative performance score was better in the virtual reality group than the video trainer group. This review has shown that virtual reality training improves standard surgical training and is at least as effective as video trainer training.

 

摘要

背景

利用虛擬實境練習針對腹腔鏡手術的訓練

手術培訓是傳統的一種學徒制度， 其中，手術受訓人應在在有訓練經驗的外科醫生的監督下學習手術操作。培訓不僅耗時而且成本昂貴，有效性也不一。這樣，使用虛擬實境練習的培訓方法變成一種選擇以此來提供標準培訓。

目標

針對虛擬實境練習針對腹腔鏡使用經歷有限或先前沒有使用經歷的手術受訓人，是否能夠補充或替代常規的腹腔鏡手術培訓 (學徒制)。

搜尋策略

我們研究截至2008年3月The Cochrane HepatoBiliary Group Controlled Trials Register, Cochrane Library的Cochrane Central Register of Controlled Trials (CENTRAL)、MEDLINE、 EMBASE、 科學引文索引和灰色文獻。

選擇標準

我們收錄所有比較虛擬實境練習和其他培訓形式的隨機臨床試驗，包括針對腹腔鏡使用經歷有限或先前沒有使用經歷的手術受訓人而展開的視訊培訓，無培訓或標準腹腔鏡培訓。我們針對這些試驗同樣地去比較這些不同虛擬實境的方法

資料收集與分析

我們收集有關試驗特性，試驗方法特質,死亡率、發病率、轉院率，手術時間和住院日等資料。我們使用有RevMan 以固定效果模式和隨機效果模式分析資料。我們根據治療意向， 計算標準平均差及其95% 信賴區間。

主要結論

我們共包括23次試驗，有612位受試者參加。4個試驗比較虛擬實境和視訊培訓人培訓。12個試驗比較虛擬實境練習和無培訓或標準腹腔鏡培訓。 4次試驗比較虛擬實境，視訊培訓人培訓和無培訓，標準腹腔鏡培訓。3個試驗比較不同的虛擬實境練習的方法。 多數試驗具有較高的誤差風險。 對於先前無手術經驗的受訓人來說，和無培訓的方法相比，虛擬實境練習能夠降低受訓人完成任務的時間、提高精確度、減少誤差；虛擬實境組比視訊培訓人訓練組更加精確。 對於腹腔鏡經驗有限的受試者來說，腹腔鏡培訓組實施虛擬實境練習比標準培訓減少更多的手術時間和誤差；虛擬實境組的手術表現的分數超過視訊培訓人組的手術表現分數。

作者結論

虛擬實境練習能夠對學徒制提供標準腹腔鏡手術培訓，至少在提供標準腹腔鏡培訓的效果上和視訊培訓人培訓一樣有效。需要實施更多的方法讓品質更好且需要更多病人相關結果的研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

虛擬實境練習能夠提供標準手術培訓: 手術培訓是傳統的一種學徒制度，其中，手術受訓人應在在有訓練經驗的外科醫生的監督下學習手術操作。培訓不僅耗時而且成本昂貴，有效性也不斷發生著變化。使用虛擬實境模擬器(電腦模擬器)的培訓方法變成一種選擇以此來提供標準培訓。我們收錄所有比較虛擬實境練習和其他培訓形式的隨機臨床試驗，包括針對腹腔鏡使用經歷有限或先前沒有使用經歷的手術受訓人而展開的視訊對照培訓，無培訓或標準腹腔鏡培訓。我們也收錄比較各種虛擬實境練習方法的試驗。一共包括23個試驗，有612位受試者參加。多數試驗具有較高的誤差風險。對於先前無手術經驗的受訓人來說，和無培訓的方法相比，虛擬實境練習能夠降低受訓人完成任務的時間，提高精確度，減少誤差。 在同一個受試者小組， 虛擬實境組的精確度大於視訊培訓人培訓組的精確度。對於腹腔鏡使用經驗有限的受試者來說，虛擬實境練習減少手術時間，提高精確度，降低了不需要的活動，比標準腹腔鏡培訓更有優勢。 在這個受試者小組中，虛擬實境組的手術表現分數超過視訊培訓人組的手術表現分數。本次文獻回顧指出虛擬實境練習可以改善標準標準手術培訓，至少和視訊培訓人培訓一樣有效。