Ensuring surgeons are well-trained in various skills is of paramount importance to patient safety. Surgical simulators were introduced to laparoscopy training during the last 2 decades for basic skills training. The main drawback of current simulation-based laparoscopy training is their lack of true representation of the intro-operative experience. To create a complete surgical surrounding, the required amount of resources is demanding. Moreover, organizing immersive training with surgical teams burdens daily clinical routines. High-end virtual reality (VR) headsets bring an opportunity to generate an immersive virtual OR with accessible and affordable expenses. Pilot studies reveal that personalization and localization are key needs of the virtual operating room (VOR). They are therefore key in this study. The focus of this study was to explore the effect of different human factors, such as domain knowledge, culture, and familiarity of VR technologies, on the perception of VOR experience. A human-centered design approach was applied to investigate the presence and usability of a VOR. Sixty-four surgical practitioners joined the study in the Netherlands and India. The surgeons were referred to as “experts” and surgical trainees as “novices.” The VOR system we used is composed of a laparoscopic simulator, a graphic virtual OR surrounding, and an Oculus Rift VR headset. Participants conducted the “complete Lapchol” task with the VOR. Afterward, four questionnaires were used to collect subjective ratings on presence and usability. Participant’s qualitative feedback was collected using a semi-structural interview as the final stage. Results showed the surgical knowledge only affected perceived mental demand when using a VOR. The cultural difference would alter the rating on the majority of items in these questionnaires. VR experience mainly affected the judgment on presence including “quality of interface” and “reversible actions.” The interaction effects between surgical knowledge either with culture difference or with VR experience were obvious. This study demonstrated the influences of cultural differences on the perception of immersion and usability. Integrating immersive technologies such as virtual reality and augmented reality to human-centered design opens a brand new horizon for health care and similar professional training.

Virtual reality (VR) training is widely used in several minimal invasive surgery (MIS) training curricula for procedural training. However, VR training in its current state lack immersive training environments, such as using head-mounted displays that is implemented in military or aviation training and even entertainment. The virtual operating room simulation setup (VORSS) is explored in this study to determine the effectiveness of immersive training in MIS. Twenty-eight surgeons and surgical trainees performed a laparoscopic cholecystectomy on the VORSS comprising of a head-mounted 360-degree realistic OR surrounding on a VR laparoscopic simulator. The VORSS replicated a full setup of instruments and surgical team-members as well as some of the distractions occurring during surgical procedures. Questionnaires were followed by semi-structured interviews to collect the data. Experts and novices found the VORSS to be intuitive and easy to use (p = 0.001). The outcome of the usability test, applying QUESI and NASA-TLX, reflected the usability of the VORSS (p < 0.05), at the cognitive level, which indicates a good sense of immersion and satisfaction, when performing the procedure within VORSS. The need for personalized experience within the setup was strongly noted from most of the participants. The VORSS for procedural training has the potential to become a useful tool to provide immersive training in MIS surgery. Further optimizing of the VORSS realism and introduction of distractors in the OR should result in an improvement of the system.

Immersive Virtual Reality (VR) laparoscopy simulation is emerging to enhance the attractiveness and realism of surgical procedural training. This study analyses the usability and presence of a Virtual Operating Room (VOR) setup via user evaluation and sets out the key elements for an immersive environment during a laparoscopic procedural training.In the VOR setup, a VR headset displayed a 360-degree computer-generated Operating Room (OR) around a VR laparoscopic simulator during laparoscopy procedures. Thirty-seven surgeons and surgical trainees performed the complete cholecystectomy task in the VOR. Questionnaires (i.e., Localized Postural Discomfort scale, Questionnaire for Intuitive Use, NASA-Task Load Index, and Presence Questionnaire) followed by a semi-structured interview were used to collect the data.The participants could intuitively adapt to the VOR and were satisfied when performing their tasks (M=3.90, IQR=0.70). The participants, particularly surgical trainees, were highly engaged to accomplish the task. Despite the higher mental workload on four subscales (p < 0.05), the surgical trainees had a lower effort of learning (4 vs 3.33, p < 0.05) compared to surgeons. The participants experienced very slight discomfort in seven body segments (0.59-1.16). In addition, they expected improvements for team interaction and personalized experience within the setup.The VOR showed potential to become a useful tool in providing immersive training during laparoscopy procedure simulation based on the usability and presence noted in the study. Future developments of user interfaces, VOR environment, team interaction and personalization should result in improvements of the system.

Background: Minimally invasive surgery requires surgeons to allocate more attention and efforts than open surgery. A surgeon’s pool of resource is affected by the multiple occurrences of interruptions and distractions in the operating room. Surgical flow disruption has been addressed from a quantitative perspective. However, little is known on its impact on the surgeons’ physiological resources. Methods: Three physiological markers, heat flux (HF), energy expenditure in metabolic equivalent of tasks and galvanic skin response were recorded using body sensor monitoring during the 21 surgical operations. The three markers, respectively, represent: stress, energy mobilization and task engagement. A total of 8 surgeons with different levels of expertise (expert vs. novice) were observed performing 21 surgical procedures categorized as short versus long. Factors of distractions were time-stamped, and triangulated with physiological markers. Two cases illustrate the impact of surgical flow disruptions on the surgeons. Results: The results indicate that expert surgeons’ mental schemata are better organized than novices. Additionally, the physiological markers indicate that novice surgeons display a higher HF at the start (tendency p =.059) and at the end of procedures (p =.001) when compared to experts. However, during longer procedures, expert surgeons have higher HF at the start (p =.041) and at the end (p =.026), than at the start and end of a short procedure. Conclusion: Data collected during this pilot study showed that interruptions and disruptions affect novice and expert surgeons differently. Surgical flow disruption appears to be taxing on the surgeons’ mental, emotional and physiological resources; as a function of the length and nature of the disruptions. Several training curricula have incorporated the use of virtual reality programs to train surgeons to cope with the new technology and equipment. We recommend integrating interruptions and distractions in virtual reality training programs as these impact the surgeons’ pool of resources.