Comparing Learning Outcomes of Virtual Reality (VR) Simulators Using Haptic Feedback Versus Box Trainer (BT) in...

Minimally invasive laparoscopic surgery requires intensive training due to challenges such as loss of haptic feedback and depth perception. Traditional training methods include box trainers (BT), which offer realistic haptic feedback but lack objective performance assessment, and virtual reality (VR) simulators, which provide automated feedback but lack haptic feedback. This review, conducted at the Barts Cancer Institute, Queen Mary University, examines the learning outcomes of VR simulators with haptic feedback compared to BT. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 2023 to April 2024. Research databases, such as PubMed, EMBASE, CINAHL, and Web of Science, were searched for randomized controlled trials (RCTs) comparing VR simulators with haptic feedback to BT in training medical students. Seven RCTs met the inclusion criteria, and four were included in the meta-analysis. The primary outcomes were learning curves and learning effects while secondary outcomes included skill transfer to a surgical environment. The review analysed data from 125 participants across the studies. Results indicated that BTs demonstrated a superior learning curve, with participants achieving proficiency faster than those using VR. Both simulators showed significant learning effects; however, BTs resulted in greater improvements across more performance parameters. Regarding skill transfer to surgical environments, there was no significant difference between the two groups, suggesting both approaches effectively support surgical skill transfer. Overall, BT has a more effective learning curve and marginally better performance in skill acquisition. While VR with haptic feedback offers enhanced realism, it does not fully replicate the natural haptic feedback provided by BT. Further studies are needed to improve VR haptic feedback and its integration into training programs to enhance learning outcomes.