Читать книгу Small Animal Laparoscopy and Thoracoscopy - Группа авторов - Страница 32

Highly realistic VR simulation (Figure 1.11) is commercially available for both basic skills as well as entire simulated surgical procedures. In fact, one of the main advantages with VR training is realistic simulation of surgical procedures, which is hard to achieve to a reasonable cost in box training. For veterinarians, this advantage is somewhat limited, though, because anatomy and surgical procedures are all based on human anatomy.

Basic task simulations give the trainee opportunity to experience a variety of surgical complications, such as bleeding, dropping clips, and repercussion from rough tissue handling while benefiting from instant and more objective motion metrics feedback and suggestions on how to proceed. Other advantages of VR simulation are that modules contain detailed instruction for performance of all tasks and summative feedback comparing the overall performance with an expert level. The summative performance is also broken down into a number of performance metrics, such as time, instrument path length for the dominant and nondominant hands, and errors, giving objective information about the performance. Therefore, the provided feedback of VR gives the trainee opportunity to practice without the need for an instructor. We have found that this instant feedback also serves as motivation because most surgeons and residents have competitive personalities and enjoy the comparison with expert level.

At present, a number of VR simulators are commercially available, but they all carry the disadvantage of being expensive. Costs range from $28 000 (LapSim Essence) to over $90 000 for units with haptic feedback (LapSim haptic, Surgical Science, Minneapolis, MN) (personal communication, Martin Jansson, GM, Surgical Science, Inc., June 2020), and software updates are also expensive. Another disadvantage is that, as mentioned, all VR simulation is based on human anatomy, and developing software for veterinary simulation is expensive; such models may not become available, at least not in the near future.

Figure 1.11 The LapSimHaptic system virtual reality trainer is combining high‐technological virtual reality exercises with haptic feedback.

Source: © Surgical Science Inc. Reproduced with permission from Surgical Science Inc.

Because of the high cost of VR training, investigations have tried to determine if VR training can be justified by being more effective than box training. A systematic review through the Cochrane Institute found that VR procedural training shows some advantage over box training in operating time and performance [25]. Similar results were reported in another recent meta‐analysis, showing that VR was associated with higher performance score during MIS, and faster completion of peg transfer task [26]. No differences were, however, demonstrated in any of 6 other outcomes parameters [26]. Some controversy seems to exist: a similar review concluded that VR and box training both are valid teaching models and that both methods are recommended in surgical curricula but with no definitive superiority of VR [27]. Important for veterinary conditions, VR procedural training may not be superior unless it is procedure specific [28], and thus it likely needs to be species specific.

In veterinary medicine, there is limited accessibility to the VR trainer. A recent study conducted by the VALT laboratory failed to demonstrate the construct validation on VR trainer [29]. Based on our experience, using VR simulator does not provide superior results compared to traditional box trainers.