Setting and study design
bleeding, hernia, injury to vessels or ductus deferens
DISSECTION, BLEEDING, COMPLICATIONS
Both studies took place in the training center for minimally invasive surgery at the Department of General, Visceral, and Transplantation Surgery at Heidelberg University Hospital. The study concerning the possible transferability of skills between VR and TS (hereafter referred to as the transferability of skills study) was designed as a prospective single center randomized crossover study. The students were randomized in a 1:1 ratio into two groups, using numbered, sealed, and opaque envelopes. The envelopes were computer-generated by an employee who was not directly involved in in the training, skills testing or data collection. Both groups were compared by the effectiveness of training a laparoscopic inguinal hernia repair. After filling out a questionnaire about baseline characteristics, the participants performed a standardized basic skills training on the VR trainer Lap Mentor™ III and on the application TS as laparoscopic preparation for the inguinal hernia module and to get used to each training platform. The basic skills training on the VR trainer was based on seven basic exercises and was performed twice by each student. After the second run on the VR trainer, phase 2 of the laparoscopic appendectomy was performed on TS, once in training mode and then once in test mode. The basic skills on the VR trainer were analyzed using the established Heidelberger VR score [Each participant performed then the inguinal hernia module on the serious gaming application TS and on the virtual reality (VR) trainer. While performing test mode on TS, students always alternated phase 1 and phase 2. In accordance with the crossover study design, participants in the TS group started with the “Laparoscopic Inguinal Hernia Module” on TS (phase 1: Patient Preparation, phase 2: Hernia Repair) and performed the module first in training, then in test mode until proficiency goals were reached. Proficiency for the laparoscopic inguinal hernia module on TS was defined as a score of 100% in both phases. The VR group started with the “Inguinal Hernia Module” on the VR trainer (task 1: Anatomy Identification, task 2: Incision and Dissection) and also performed the module until proficiency was reached. Proficiency for the inguinal hernia module on the VR trainer was defined for task 1 as correctly identifying every anatomical structure on the first attempt and for task 2 as completing the procedure without complications (injury to vessels or ductus deferens, unstoppable bleeding). Once proficiency goals were reached, the groups switched modalities, and the students performed on the other training modality until the proficiency goals were reached (Fig. Flowchart for potential transferability of skills study curve comparison between TS and VR group