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Validity and usability of a virtual reality intraocular surgical simulator

Selvander, Madeleine LU (2013) In Lund University Faculty of Medicine Doctoral Dissertation Series 2013:48.
Abstract
Cataract surgery is one of the most common surgical procedures in Sweden and around 90 000 operations are made each year. An aging population with increased demands on quality of life and good visual acuity, has led to an increased rate of surgery and more surgeons needs to be trained. Training of new cataract surgeons is done on scarce wet-lab training but mainly on patients. Training is costly and complications are higher for new surgeons compared to experienced ones. In the airline industry simulators are used for training. Pilots have to prove competent before flying a new airplane. No such standards exist for new cataract surgeons.

Surgical simulators have been used in other surgical fields for training and reports have shown... (More)
Cataract surgery is one of the most common surgical procedures in Sweden and around 90 000 operations are made each year. An aging population with increased demands on quality of life and good visual acuity, has led to an increased rate of surgery and more surgeons needs to be trained. Training of new cataract surgeons is done on scarce wet-lab training but mainly on patients. Training is costly and complications are higher for new surgeons compared to experienced ones. In the airline industry simulators are used for training. Pilots have to prove competent before flying a new airplane. No such standards exist for new cataract surgeons.

Surgical simulators have been used in other surgical fields for training and reports have shown that training has improved performance on real operations. The purpose of this work was to validate Eyesi, a surgical simulator for cataract surgery training, and analyze learning curves. Furthermore we set out to investigate whether factors like stereoacuity and sex would be important for performance in the simulator.

Evidence for construct validity was found for cataract specific modules capsulorhexis, hydromaneuvers and phaco divide and conquer and for manipulating modules cataract navigation training, cataract forceps training and cataract cracking and chopping training. Analysis of learning curves showed significant improvement throughout training. Evidence for concurrent validity was established for the capsulorhexis module. For the hydromaneuvers and phaco modules, the innate simulator scoring could not distinguish surgical skill but discrimination was dependent on video based human scoring.

Stereoacuity was found to correlate with performance on the simulator but there were large individual variations. An individual’s sex had no influence on performance.

We have shown that Eyesi can differentiate cataract surgical skill and that naïve can train in the simulator and improve. Stereoacuity has an effect on performance but there were large individual variations. Simulation-based training has the potential to move the early learning curve out of the operating room. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Gråstarrskirurgi är en av de vanligaste kirurgiska ingreppen i Sverige med runt 90 000 operationer utförda varje år. En åldrande befolkning med ökade krav på livskvalitet och god synskärpa har lett till en ökad operationsfrekvens och fler kirurger behöver utbildas. Utbildning av nya gråstarrskirurger sker förutom ett fåtal träningstillfällen på grisar, framförallt på patienter. Utbildning är kostsam och komplikationer är högre för nya kirurger jämfört med erfarna. Inom flygindustrin används simulatorer för utbildning av nya piloter. Piloter måste klara fastställda krav innan de flyger nya plan. Ingen sådan standard finns för blivande gråstarrskirurger.

Kirurgisimulatorer har använts... (More)
Popular Abstract in Swedish

Gråstarrskirurgi är en av de vanligaste kirurgiska ingreppen i Sverige med runt 90 000 operationer utförda varje år. En åldrande befolkning med ökade krav på livskvalitet och god synskärpa har lett till en ökad operationsfrekvens och fler kirurger behöver utbildas. Utbildning av nya gråstarrskirurger sker förutom ett fåtal träningstillfällen på grisar, framförallt på patienter. Utbildning är kostsam och komplikationer är högre för nya kirurger jämfört med erfarna. Inom flygindustrin används simulatorer för utbildning av nya piloter. Piloter måste klara fastställda krav innan de flyger nya plan. Ingen sådan standard finns för blivande gråstarrskirurger.

Kirurgisimulatorer har använts inom andra kirurgiska discipliner för träning och utbildning och rapporter har visat att simulatorträning har förbättrat utfall vid verkliga operationer. Syftet med detta arbete var att utvärdera Eyesi, en simulator för träning av gråstarrskirurgi, och undersöka inlärningskurvor. Dessutom ville vi undersöka om faktorer som stereoseende och en persons kön skulle ha betydelse för hur man presterade i simulatorn.

Vi fann att gråstarrskirurger klarade träningen i simulatorn bättre än icke-kirurger. Analys av inlärningskurvor visade klar förbättring vid träning. En individs stereoseende visade sig korrelera med prestation i simulatorn så att ju bättre stereoseende desto bättre prestation men det var stora individuella variationer. Vi såg ingen skillnad i prestation mellan män och kvinnor. Simulatorbaserad träning av gråstarrskirurgi har en potential att flytta den första delen av inlärning ut ur operationsrummet. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • MD, PhD Söderberg, Per, Department of Neuroscience, Uppsala University, Uppsala
organization
publishing date
type
Thesis
publication status
published
subject
keywords
simulator, cataract surgery, learning, training, Eyesi
categories
Higher Education
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2013:48
pages
104 pages
publisher
Department of Clinical Sciences, Lund University
defense location
MFC Lilla Aulan, Jan Waldenströms gata 5, Ingång 59, Skånes Universitetssjukhus
defense date
2013-05-17 13:00:00
ISSN
1652-8220
ISBN
978-91-87449-18-5
language
English
LU publication?
yes
id
987e130f-e59c-49f7-beac-8ea44ebcf960 (old id 3690977)
date added to LUP
2016-04-01 13:00:00
date last changed
2019-05-22 00:40:04
@phdthesis{987e130f-e59c-49f7-beac-8ea44ebcf960,
  abstract     = {Cataract surgery is one of the most common surgical procedures in Sweden and around 90 000 operations are made each year. An aging population with increased demands on quality of life and good visual acuity, has led to an increased rate of surgery and more surgeons needs to be trained. Training of new cataract surgeons is done on scarce wet-lab training but mainly on patients. Training is costly and complications are higher for new surgeons compared to experienced ones. In the airline industry simulators are used for training. Pilots have to prove competent before flying a new airplane. No such standards exist for new cataract surgeons.<br/><br>
Surgical simulators have been used in other surgical fields for training and reports have shown that training has improved performance on real operations. The purpose of this work was to validate Eyesi, a surgical simulator for cataract surgery training, and analyze learning curves. Furthermore we set out to investigate whether factors like stereoacuity and sex would be important for performance in the simulator.<br/><br>
Evidence for construct validity was found for cataract specific modules capsulorhexis, hydromaneuvers and phaco divide and conquer and for manipulating modules cataract navigation training, cataract forceps training and cataract cracking and chopping training. Analysis of learning curves showed significant improvement throughout training. Evidence for concurrent validity was established for the capsulorhexis module. For the hydromaneuvers and phaco modules, the innate simulator scoring could not distinguish surgical skill but discrimination was dependent on video based human scoring.<br/><br>
Stereoacuity was found to correlate with performance on the simulator but there were large individual variations. An individual’s sex had no influence on performance.<br/><br>
We have shown that Eyesi can differentiate cataract surgical skill and that naïve can train in the simulator and improve. Stereoacuity has an effect on performance but there were large individual variations. Simulation-based training has the potential to move the early learning curve out of the operating room.},
  author       = {Selvander, Madeleine},
  isbn         = {978-91-87449-18-5},
  issn         = {1652-8220},
  language     = {eng},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University Faculty of Medicine Doctoral Dissertation Series},
  title        = {Validity and usability of a virtual reality intraocular surgical simulator},
  url          = {https://lup.lub.lu.se/search/ws/files/3099963/3690978.pdf},
  volume       = {2013:48},
  year         = {2013},
}