A feasibility study: a non-inferiority study comparing head-mounted and console-based virtual reality for robotic...

Head-mounted virtual reality (VR) simulations are increasingly explored in healthcare, particularly in patient education, stroke rehabilitation, and surgical training. While VR-based simulation plays a growing role in robotic-assisted surgery (RAS) training, the implications of head-mounted VR in this context remain underexamined.

This prospective, randomised, controlled trial with a single-arm crossover compared two training modalities: a head-mounted VR simulation and a conventional console-based simulation. Participants in the experimental group used head-mounted VR as their primary training method, while the control group trained on a conventional console. Both groups completed a running suture task at baseline, midterm, and final assessments on the surgical console. The primary outcome was the composite score from the final assessment.

Fourteen participants were equally distributed between the two arms. Baseline scores showed no significant differences. A two-way repeated measures ANOVA demonstrated significant overall improvement across assessments (F (1.688, 20.26) = 48.34, p < 0.001, partial η² = 0.80). No statistical difference was found in final composite scores (mean difference: 8.4 ± 9.45, p = 0.391, Cohen's d = -0.48), midterm scores, or granular kinematic data. However, non-inferiority could not be established as the confidence interval fell outside our pre-set margin. The crossover group required less time (mean difference: 39 ± 9.01 min, p = 0.004) and fewer attempts (mean difference: 8 ± 2.2, p = 0.009) to reach benchmark performance compared to the control group.

Both head-mounted VR and console-based training significantly improved fundamental RAS skills in novices. While our study showed that the VR training shortened the time and attempts required to reach proficiency benchmarks, the small scale of this trial and the breadth of the confidence intervals mean the results should be viewed as preliminary observations. These results provide an initial signal of feasibility that warrants confirmation in larger studies.