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Svenja Deuchler, Clemens Wagner, Pankaj Singh, Rami Al-Dwairi, michael mueller, Rachid Benjilali, Adonis Chedid De Robaulx, Thomas Kohnen, Markus Schill, Frank H J Koch; Can the daily condition of the surgeon be measured in simulated surgery ?. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5125.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate whether the virtual reality performance in the ophthalmic surgical simulator Eyesi® allows to draw conclusions about the expected actual pars plana vitrectomy (PPV) performance in the operating room (OR).
Five vitreoretinal surgeons performed simulator training with an abstract bimanual task, two peelings and simulated retinal detachment surgery on several days. None of the surgeons had performed intraocular surgery for at least 48 hrs. The average performance and variability of a surgeon in all his simulator trainings was taken as a baseline. In order to get a measure for his actual performance, a relative simulator score was calculated by comparing his current score with the standard deviation (SD) window. Scores outside this window were classified as exceptionally good (5) or bad (1), scores that deviated less than half the SD as normal (3). When the surgeon went to the OR the PPV intervention was video-taped to be ready for evaluation through blinded observers.
We analyzed 10 surgeries with a score in the OR between 2,9 and 4,9. Three surgeries were preceeded by poor results in the simulator (relative scores < 2). These three surgeries were the only ones with an OR score < 3,5, all other surgeries had an OR score > 4.<br /> The governing factor of low scores in the simulator were iatrognic retinal holes, retinal bleeding and lens damage (the surgeons with OR scores < 3,5 got 128, 144, and 156 points off). This score was remarkably lower for surgeons that performed well in the OR (7 surgeries, average of 51 points off with a SD of 45 points).
Despite the small data basis and the large variation of conditions (five surgeons, treating different pathologies, ten samples), a promising relation between the performance in the simulator and in the OR can be found.<br /> Many questions have to be addressed and answered in our consecutive studies. Is the observed relation statistically significant? Can it be used to define a threshold for entering the OR ? Could an extended training in the simulator be used as a warmup that compensates for daily performance variations and improves the average performance in the OR ?<br /> Yousuf M. Khalifa et al.. Virtual Reality in Ophthalmology Training. Survey of Ophthalmology 51: 259 - 273 (2006)<br /> Colin McCannel et al.. Ophthalmic Surgery Simulator Training Improves Resident Performance of Capsulorhexis in the Operating Room. Ophthalmology 120: 2456-61(2013)
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