Abstract
Purpose: :
To present a pilot study about the impact of training in the simulator Eyesi® onto the surgeon’s performance in the operating room (VR-to-OR effect).
Methods: :
Based on different vitreoretinal modules implemented in the simulator Eyesi®, we detect criteria which reflect the impact of simulator training onto the operating room (OR) performance of 4 surgeons providing vitreoretinal service in 40 eyes. Shortly before performing surgery in a patient’s eye, the surgeon who accomplishes the needs for the patient’s eye best is randomized for no training or training on the simulator prior to the surgery. Simulator based training comprises abstract testing, ILM peeling (dominant and non-dominant hand) and retinal re-attachment procedures. Surgery in the simulator as well as in the OR is recorded for evaluation.
Results: :
After training in the simulator, in 92% of the interventions surgeons walk up to the OR with higher confidence about the procedure they have to perform in the patient’s eye. All surgeons throughout the whole study confirm this. When surgery in the patient's eye follows the training immediately, all simulator trained surgeons describe less difficulties to string single steps of the procedure together with more safety and easiness. This includes basic procedures like the adjustment of the microscope and the focusing down to the retina with special widefield observation optics as well as complex maneuvers like retinal reattachment and laser coagulation. 2 surgeons describe that they could easier finish a certain task with the non-dominant hand.
Conclusions: :
From an ethical standpoint, VR-to-OR studies evaluating training effects in a simulator are barely possible to be performed.1 Neither can surgeons with different training levels be randomized and compared to each other, nor is it likely that vitreoretinal interventions in two eyes can be reasonably compared. The approach chosen in this study is to determine which surgeon accomplishes the needs of the patients eye best and then analyze whether and how simulator training does affect the surgeon’s performance.We do know from training in Eyesi® 2-4 that consequent training comes along with a better performance in the simulator as the success rate goes up and the time spent in the eye goes down. Whether and how the management of certain simulated procedures correlates with the OR performance is currently be analyzed by independent blinded observers who are provided with data recorded either on the simulator or in the OR.References1 Khalifa YM et al. Surv Ophthalmol.51: 259-73 (2006) 2. Solverson DJ et al. Simul Healthc. Summer 4: 98-103 (2009). 3. Waqar S et al. Graefes Arch Clin Exp Ophthalmol. 249: 77-81 (2011). 4. Koch F et al. Klin Monatsbl Augenheilkd. 226: 672-676 (2009)
Keywords: vitreoretinal surgery • learning • retinal detachment