SlingVR: A Virtual Reality Surgical Training System for Haptic-based "Blind" Surgical Procedures

"Blind" procedures are performed without visual feedback and rely on haptics to complete the operation safely "by feel." Current training methods, including static models, cadaver sections, or supervised practice on patients, are expensive, time-consuming, and could impact patient safety. Simulation trainers that provide haptic feedback are still limited in their ability to reproduce realistic feel and accurately provide performance data. This study describes the concept, development, and usability evaluation of the SlingVR Surgical Training System for "blind" procedures.

A multidisciplinary team developed a SlingVR simulation prototype for blind procedures. A cognitive task analysis was used to understand how training design characteristics impacted learning and fidelity of the SlingVR system.

Data were collected in multiple remote locations during multiple cycles of testing.

The system and training experience was evaluated by expert surgeons and novices (medical students).

Participants performed the miduretheral sling procedure using the SlingVR virtual reality haptic-based trainer.

A usability survey and semistructured qualitative interviews were completed after using the tool. Qualitative comments and investigator observations during the sessions were reviewed and summarized into themes.

Six themes were identified from feedback of 14 expert surgeons: (1) cognitive tasks and knowledge improvement, (2) system feedback amount and type, (3) scoring and proficiency, (4) immersion/realism, (5) design elements/esthetics, (6) gestalt/impressions. In phase two, 17 novices rated the training highly effective (mean = 4.44 ± 0.54, 11 items) with high usability (mean = 4.49 ± 0.49, 10 items, α = 0.87) and moderately high fidelity (mean = 4.06 ± 0.62, 8 items, α = 0.87). The visual realism of the pelvic model was rated highest (mean = 4.33 ± 0.77), and haptics were realistic. Overall, 82% agreed that the system increased their confidence in performing the procedure.

We developed an innovative and valuable way to teach blind surgeries like the retropubic midurethral sling using virtual reality and haptics to avoid practicing on patients or using cadaver models. Overall, the SlingVR system was rated easy to use and visually and tactically realistic. Novices found the training to be high fidelity, comfortable, clear, and effective.