Computerized simulation (CS) of surgery in virtual reality (VR), augmented reality (AR) and mixed reality (MR) settings are used to teach foundational skills, but its applicability in advanced training is to be determined. This review aims to summarize the types of CS available for laparoscopic colorectal surgery (CRS) and its utility in assessment of proficiency.
Methods
A systematic review of CS in laparoscopic CRS was done on PubMed, Embase, Scopus and Cochrane Library databases.
Results
Eleven relevant observational studies were identified. The most common procedure simulated was laparoscopic colectomy. Assessment using performance metrics measured by the simulator such as path length moved by laparoscopic tools, procedure time and number of discrete movements had the most consistent differentiating ability between expert and non-expert cohorts. Surgeons fared similarly in proficiency scores in assessment with CS compared to assessment with traditional cadaveric or porcine models.
Conclusion
CS of laparoscopic CRS may be used in assessment of proficiency using performance metrics measuring economy of movement. CS may be a viable assessment tool in advanced surgical training, but further studies should assess utility of incorporating it as a formal assessment tool in training programs.
ChanKSShelatVG. We asked the experts: emerging role of youtube surgical videos in education and training. World J Surg. 2021;45(2):417-419. doi:10.1007/s00268-020-05660-6.
2.
AraujoSEAPerezROKlajnerS. Role of simulation-based training in minimally invasive and robotic colorectal surgery. Clin Colon Rectal Surg. 2021;34(3):136-143. doi:10.1055/s-0040-1718687.
3.
LunguAJSwinkelsWClaesenLTuPEggerJChenX. A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery. Expert Review of Medical Devices. 2021;18(1):47-62. doi:10.1080/17434440.2021.1860750.
4.
PalterVNGrantcharovTP. Virtual reality in surgical skills training. Surg Clin North Am. 2010;90(3):605-617. doi:10.1016/j.suc.2010.02.005.
5.
AlakerMWynnGRArulampalamT. Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis. Int J Surg. 2016;29:85-94. doi:10.1016/j.ijsu.2016.03.034.
6.
GuedesHGCâmara Costa FerreiraZMRibeiro de Sousa LeãoLSouza MonteroEFOtochJPArtifonELA. Virtual reality simulator versus box-trainer to teach minimally invasive procedures: a meta-analysis. Int J Surg. 2019;61:60-68. doi:10.1016/j.ijsu.2018.12.001.
7.
NagendranMGurusamyKSAggarwalRLoizidouMDavidsonBR. Virtual reality training for surgical trainees in laparoscopic surgery. Cochrane Database Syst Rev. 2013;2013(8):Cd006575. doi:10.1002/14651858.CD006575.pub3.
8.
HummGMohanHFlemingC, et al.The impact of virtual reality simulation training on operative performance in laparoscopic cholecystectomy: meta-analysis of randomized clinical trials. BJS Open. 2022;6(4):86. doi:10.1093/bjsopen/zrac086.
9.
Beyer-BerjotLPalterVGrantcharovTAggarwalR. Advanced training in laparoscopic abdominal surgery: a systematic review. Surgery. 2014;156(3):676-688. doi:10.1016/j.surg.2014.04.044.
10.
SankaranarayananGParkerLDeSKapadiaMFicheraA. Simulation for colorectal surgery. J Laparoendosc Adv Surg Tech A. 2021;31(5):566-569. doi:10.1089/lap.2021.0096.
11.
PageMJMcKenzieJEBossuytPM, et al.The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372:n71. doi:10.1136/bmj.n71
12.
DownsSHBlackN. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377-384. doi:10.1136/jech.52.6.377.
13.
MoriTIkedaKTakeshitaNTeramuraKItoM. Validation of a novel virtual reality simulation system with the focus on training for surgical dissection during laparoscopic sigmoid colectomy. BMC Surg. 2022;22(1):12. doi:10.1186/s12893-021-01441-7.
14.
WynnGLykoudisPBerlingieriP. Development and implementation of a virtual reality laparoscopic colorectal training curriculum. Am J Surg. 2018;216(3):610-617. doi:10.1016/j.amjsurg.2017.11.034.
15.
GallagherAGHennPJNearyPC, et al.Outlier experienced surgeon's performances impact on benchmark for technical surgical skills training. ANZ J Surg. 2018;88(5):E412-E417. doi:10.1111/ans.14474.
16.
MuralhaNOliveiraMFerreiraMACosta-MaiaJ. Virtual reality simulation as a tool to monitor surgical performance indicators: VIRESI observational study. Article. Acta Med Port. 2017;30(5):388-394. doi:10.20344/amp.7983.
17.
Beyer-BerjotLBerdahSHashimotoDADarziAAggarwalR. A virtual reality training curriculum for laparoscopic colorectal surgery. J Surg Educ. 2016;73(6):932-941. doi:10.1016/j.jsurg.2016.05.012.
18.
AraujoSESeidVEBertonciniABHorcelLANahasSCCecconelloI. Single-session baseline virtual reality simulator scores predict technical performance for laparoscopic colectomy: a study in the swine model. J Surg Educ. 2014;71(6):883-891. doi:10.1016/j.jsurg.2014.05.017.
19.
ShanmuganSLeblancFSenagoreAJ, et al.Virtual reality simulator training for laparoscopic colectomy: what metrics have construct validity?Dis Colon Rectum. 2014;57(2):210-214. doi:10.1097/dcr.0000000000000031.
20.
LeblancFSenagoreAJEllisCN, et al.Hand-assisted laparoscopic sigmoid colectomy skills acquisition: augmented reality simulator versus human cadaver training models. J Surg Educ. 2010;67(4):200-204. doi:10.1016/j.jsurg.2010.06.004.
21.
LeblancFDelaneyCPEllisCNNearyPCChampagneBJSenagoreAJ. Hand-assisted versus straight laparoscopic sigmoid colectomy on a training simulator: what is the difference? A stepwise comparison of hand-assisted versus straight laparoscopic sigmoid colectomy performance on an augmented reality simulator. World J Surg. 2010;34(12):2909-2914. doi:10.1007/s00268-010-0765-0.
22.
EssaniRScrivenRMcLartyAMerriamLAhnHBergamaschiR. Simulated laparoscopic sigmoidectomy training: Responsiveness of surgery residents. Diseases of the colon and rectum. 2009;52(4):802. American Society of colon and rectal surgeons Annual Meeting. Hollywood, FL United States. (var.pagings).
23.
NearyPCBoyleEDelaneyCPSenagoreAJKeaneFBGallagherAG. Construct validation of a novel hybrid virtual-reality simulator for training and assessing laparoscopic colectomy; results from the first course for experienced senior laparoscopic surgeons. Surg Endosc. 2008;22(10):2301-2309. doi:10.1007/s00464-008-9900-5.
24.
SarkerSKKumarIDelaneyC. Assessing operative performance in advanced laparoscopic colorectal surgery. World J Surg. 2010;34(7):1594-1603. doi:10.1007/s00268-010-0486-4.
25.
SungHFerlayJSiegelRL, et al.Global cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660.
26.
WakaharaTToyokawaAAshitaniHTsuchidaSHasegawaY. Comparison of laparoscopic sigmoidectomy with and without preservation of the superior rectal artery: a single-institution retrospective study. Asian J Endosc Surg. Feb. 2015;8(1):29-33. doi:10.1111/ases.12142.
27.
AminMBEdgeSBGreeneFL, et al.AJCC Cancer Staging Manual. New York: Springer International Publishing; 2018.
28.
YangYWangGHeJZhangJXiJWangF. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a meta-analysis. Int J Surg. 2018;52:20-24. doi:10.1016/j.ijsu.2017.12.030.
29.
Evans*AMcKennaCOliverM. Trainees' perspectives on the assessment and self‐assessment of surgical skills. Assessment & Evaluation in Higher Education. 2005;30(2):163-174.
30.
MartinJRegehrGReznickR, et al.Objective structured assessment of technical skill (OSATS) for surgical residents. British journal of surgery. 1997;84(2):273-278.
31.
PagadorJBSánchez-MargalloFMSánchez-PeraltaLF, et al.Decomposition and analysis of laparoscopic suturing task using tool-motion analysis (TMA): improving the objective assessment. Int J Comput Assist Radiol Surg. 2012;7(2):305-313. doi:10.1007/s11548-011-0650-9.
32.
de MontbrunSLRobertsPLLowryAC, et al.A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the colorectal objective structured assessment of technical Skill (COSATS). Ann Surg. 2013;258(6):1001-1006. doi:10.1097/SLA.0b013e31829b32b8.
33.
ChanKSWangZKSynNGohBKP. Learning curve of laparoscopic and robotic pancreas resections: a systematic review. Surgery. 2021;170(1):194-206. doi:10.1016/j.surg.2020.11.046.
34.
OdermattMKhanJParvaizA. Supervised training of laparoscopic colorectal cancer resections does not adversely affect short- and long-term outcomes: a propensity-score-matched cohort study. World J Surg Oncol. 2022;20(1):98. doi:10.1186/s12957-022-02560-y.
35.
KulaylatASPappouEPhilpMM, et al.Emergent colon resections: does surgeon specialization influence outcomes?Diseases of the Colon & Rectum. 2019;62(1):1.
36.
van ZwietenTOkkemaSvan DetMPereboomIVeegerNPierieJP. Assessment methods in laparoscopic colorectal surgery: a systematic review of available instruments. Int J Colorectal Dis. 2023;38(1):105. doi:10.1007/s00384-023-04395-9.
37.
PalterVNGrantcharovTP. Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial. Ann Surg. 2012;256(1):25-32. doi:10.1097/SLA.0b013e318258f5aa.
38.
HogleNJLiuYOgdenRTFowlerDL. Evaluation of surgical fellows' laparoscopic performance using global operative assessment of laparoscopic skills (GOALS). Surg Endosc. 2014;28(4):1284-1290. doi:10.1007/s00464-013-3324-6.
39.
MiskovicDNiMWylesSMTekkisPHannaGB. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum. 2012;55(12):1300-1310. doi:10.1097/DCR.0b013e31826ab4dd.
40.
AggarwalRCrochetPDiasAMisraAZiprinPDarziA. Development of a virtual reality training curriculum for laparoscopic cholecystectomy. British Journal of Surgery. 2009;96(9):1086-1093. doi:10.1002/bjs.6679.
41.
ReitanoEde'AngelisNSchembariE, et al.Learning curve for laparoscopic cholecystectomy has not been defined: a systematic review. ANZ J Surg. 2021;91(9):E554-E560. doi:10.1111/ans.17021.
42.
SheetzKHClaflinJDimickJB. Trends in the Adoption of robotic surgery for common surgical procedures. JAMA Netw Open. 2020;3(1):e1918911. doi:10.1001/jamanetworkopen.2019.18911.
43.
GohBKTeoRY. Current Status of laparoscopic and robotic Pancreatic surgery and its Adoption in Singapore. Ann Acad Med Singap. Jun. 2020;49(6):377-383.
SaqibSUBajwaAA. The role of Da Vinci Xi robotic simulation curriculum in enhancing skills in robotic colorectal surgery. Ann Med Surg (Lond). 2023;85(12):6001-6007. doi:10.1097/ms9.0000000000001342.
46.
ChanKSOoAM. Exploring the learning curve in minimally invasive esophagectomy: a systematic review. Dis Esophagus2023;36(9). doi:10.1093/dote/doad008. 36857586In press.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
