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Frank H J Koch, Clemens Wagner, Pankaj Singh, Michael Mueller, Rachid Benjilali, Markus Schill, Hanns Ackermann, Dimitra Bon, Benjamin Schoene, Michael Koss, Svenja Deuchler; Simulated vitreoretinal surgery to prepare for real surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1076.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of the virtual reality training simulator Eyesi® to prepare surgeons with different skill profile for performing pars plana vitrectomies (PPV).
Four vitreoretinal surgeons with different expertise were randomized into two groups. One group (n=9) prepared their surgery with a standardized simulator training before starting the PPV in the operating room. The second group went directly to the operating room (n=12). Two blinded observers (one repeating the analysis for intra-observer consistency) enabled us to analyze the effect of warming up onto the operating room performance.
When comparing the two groups (n=21), the statistical analysis with a mixed-model approach for repeated measurements showed a significant effect (p=0.0302) of warmup training onto the final outcome in the operating room. Regarding the evaluation of the two independent observers, the Shrout-Fleiss intraclass correlation with a two-way mixed, single measure model resulted in a correlation coefficient of ICC (3,1) = 0.97 and a 95% confidence interval of 0.872..0.994. With respect to the intraindividual regrading, the Bland-Altman intraclass correlation resulted in a correlation coefficient of ICC = 0.99 with a 95% confidence interval of 0.981..0.998. The standard deviation of the three less experienced surgeons was rather high with SD=0.76 (n=14) whereas the scores of an expert surgeon varied considerably less with SD=0.21 (n=7). An f-test showed with p=0.004 that this difference between the less experienced surgeons and the expert was significant (Fig.1).
Of the studies evaluating the role of training on Eyesi in either the anterior or the posterior eye segment, to our knowledge, there is none that investigates the warmup effect of simulator training.Despite the large variation of conditions, the effect of a warmup training was found with statistical significance.Simulator training is able to serve as a warmup to increase the average performance.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Fig.1 Effect of warmup training; compares the years of experience (x-axis), the average scores of the video analysis with and without warmup (y-axis) and their standard deviation. The surgeons have unique years of experience (2/3/7/25), therefore each x-value represents one specific surgeon. The least experienced surgeon always had to warm up. The warmup training increases the final outcome in the operating room by 0.5 to 1 points.
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