Table 1.
Studies included assessing the use of VR/AR in thoracic surgery training
| Study | Year | Study characteristics | Population number | Simulation technique employed | Main reported outcomes |
|---|---|---|---|---|---|
| Jensen et al. | 2014 | R, M, P | 28 |
• 2 randomized trainee groups. Group 1 computer-based VR simulator from SimSurgery called SEP, simulated VR nephrectomy. Group 2 black-box training. • After a retention period they performed a thoracoscopic lobectomy on a porcine model. |
• No difference between the 2 groups was found in terms of bleeding and anatomical and non-anatomical errors. • The performance of the black box trained group was faster during the test task 26.6 min (SD 6.7 min) vs 32.7 min (SD 7.5 min) with VR. |
| Jensen et al. | 2015 | NR, M, P | 103 |
• 3 groups: novices n = 32, intermediates n = 45 and experienced n = 26. • A VR VATS simulator was tested with a computer monitor as interface. • A complete endoscopic non-rib-spreading technique was taken based on an anterior view of the hilum. |
• The graphics and movements were found to be realistic all participants. • Novice and intermediate participants found the scenario to be highly useful. However, usefulness was rated as low by experienced thoracic surgeons. • No statistically significant difference in terms of metric scores was found between all groups. |
| Jensen et al. | 2016 | NR, M, P | 53 |
• 3 groups: novices n = 17, intermediates n = 22 and experienced n = 14. • Based on the standardized anterior approach, a virtual reality VATS simulator through a screen monitor as interface was developed. • VR simulators used were LapSim (Surgical Science, Gothenburg, Sweden) to perform a VATS right upper lobectomy. |
• They established validity evidence for the VATS simulator. • Significant correlations were found between the simulation metric and level of experience of the participants. • A pass/fail level was defines based on mean scores (±1 standard deviation). All of the novice surgeons and 2 of the experiences surgeons failed to pass the simulation based on the calculated mean. |
| Gopal et al. | 2018 | NR, NM, P | 47 |
• 1 group of medical students. • EndoVR endoscopy simulator (CAE Healthcare, Montreal, Quebec, Canada), a high-fidelity, haptic feedback simulator was used to perform Bronchoscopy simulation. • Bronchoscopy Skills and Tasks Assessment Tool (BSTAT) was used to assess performance. |
• A significant increase in BSTAT score, bronchial anatomy knowledge, bronchial navigational skills was noted through VR simulation in medical students. |
| Jensen et al. | 2019 | NR, M, P | 53 |
• All participants with no experience of VR simulations performed 2 VR VATS operations. • The VATS lobectomy assessment tool (VATSAT) was used consisting of 8 items especially developed to rate trainees’ VATS lobectomies competencies. |
• Validity evidence was provided for a novel assessment tool for evaluating VATS lobectomy competence. • The VATSAT proved to be a specific assessment tool for evaluating VATS lobectomy performance. • The participants VATS lobectomy experience was found to correlate to their score in the simulator. |
| Whittaker et al. | 2019 | NR, M, P | 30 |
• 3 groups: novices n = 16, intermediates n = 9 and experienced n = 5. • Thoracic robotic lobectomy was simulated using RobotiX Mentor. The system provides step-by-step instructions to robot-assisted right upper lobectomy. |
• Realism was rated 3/5 both for the simulator and the module. • The simulator was rate 3.8/5 as acceptable and 3.8/5 as feasible. • Face validity, acceptability and feasibility were ascertained for simulator. |
| Qin et al. | 2019 | NR, NM, P | 32 |
• 2 groups: novices n = 24, experienced n = 8. All participants were thoracic surgeons. • The VatsSim-XR simulator consisting of a 3D display, haptic enabled thoracoscopic instruments, endoscope kit and a VR headset. • AR, VR, CVR, MR and black box simulators were compared in peg transfer procedure simulating thoracic tasks. |
• Performance level was linked to the experience of the practitioners. • AR provided more balanced training environment based on fidelity and accuracy. • Box and MR have the best realism perception and surgical performance. |
AR: augmented reality; M: multicentre; NM: non-multicentre; NP: non-prospective; NR: non-randomized; P: prospective; R: randomized; VATS: video-assisted thoracic surgery; VR: virtual reality.