Cataract surgery in a simulated operating room environment: a pilot study

To evaluate whether incorporating contextual operating room (OR) elements into cataract surgery simulation influences cardiovascular responses, subjective stress, and surgical performance.

A prospective, within-subject crossover study.

Ten ophthalmic surgeons (5 senior residents and 5 board-certified cataract surgeons) from the ophthalmology department and simulation laboratory at Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada.

Participants performed cataract surgeries under 3 conditions: real surgery (Real), standard virtual reality simulation on the EyeSi Surgical (LoFi), and simulated OR environment integrating the EyeSi simulator with surgical equipment, ambient sounds, and interactions with the patient and surgical staff (HiFi). Participants completed 3 procedures per condition. Physiological responses were assessed using heart rate (HR) and heart rate variability (HRV), and subjective stress ratings were collected. Technical performance was measured through expert video assessment using the Objective Structured Assessment of Cataract Surgical Skills and simulator-generated scores.

Seventy-eight procedures were analyzed. The HiFi condition was associated with significantly higher average and peak HR compared with LoFi (92 ± 17 vs 82 ± 11 bpm; p < 0.0001; 112 ± 17 vs 103 ± 15 bpm; p = 0.01). The temporal HR pattern in the HiFi condition more closely resembled that observed during real surgery. Technical performance remained comparable between HiFi and LoFi. No significant differences were observed in HRV metrics or subjective stress ratings.

Cataract surgery in a simulated OR environment was associated with increased cardiovascular activation and a heart rate pattern resembling real surgery, without impairing technical performance. This approach may support the training of both technical and nontechnical surgical skills in a controlled learning environment.