Hysteroscopic resection on virtual reality simulator: What do we measure?

Area of Science:

• Gynecologic Surgery
• Medical Simulation
• Surgical Education

Background:

• Hysteroscopy resection is a key gynecologic procedure.
• Objective assessment of surgical skill is crucial for training.
• Virtual reality simulators offer a standardized platform for skill evaluation.

Purpose of the Study:

• To compare novice and expert performance on a virtual reality hysteroscopy simulator.
• To validate a multimetric score for assessing surgical skill.
• To evaluate the construct validity of the HystSim™ simulator.

Main Methods:

• Nineteen expert gynecologists and 20 novice residents performed four standardized hysteroscopy resection cases on the HystSim™ simulator.
• Performance metrics included overall score and an "economy score" (path length, procedure time, camera alignment).
• Statistical analysis using the Mann-Whitney test compared novice and expert performance.

Main Results:

• The overall score significantly differed between novices and experts for polypectomy, myomectomy, and roller ball endometrial ablation (P<0.001).
• No significant difference was observed in the overall score for septum resection (P=0.456).
• The economy score demonstrated significant differences between skill levels across all four procedures (P<0.001 for polypectomy, myomectomy, and roller ball; P=0.001 for septum resection).

Conclusions:

• The HystSim™ overall score effectively differentiates novice from expert surgeons for most hysteroscopy resection tasks.
• The economy score is a reliable metric for reflecting surgeon experience in virtual reality hysteroscopy simulation.
• This simulator can be utilized for evaluating and training gynecologic surgeons in hysteroscopic resection techniques.