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

Gilles C Martin1, Arnaud Huaulmé2, Mathieu Cavaillé3

  • 1Ophthalmology Department, Rothschild Foundation Hospital, Paris, France; Université de Rennes, Institut National de la Santé et de la Recherche Médicale, Laboratoire Taitement du Signal et de l'Image, Rennes, France; Ophthalmology Department, University of Montreal, Montreal, QC; Centre d'Apprentissage des Attitudes et Habiletés Cliniques et Centre de Recherche en Pédagogie de la Santé, University of Montreal, Montreal, QC; Maisonneuve-Rosemont Hospital, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, QC.

Canadian Journal of Ophthalmology. Journal Canadien D'Ophtalmologie
|March 27, 2026
PubMed

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Summary

Simulating cataract surgery in a high-fidelity operating room (OR) environment increased cardiovascular responses, mirroring real surgery. This advanced simulation did not compromise surgical skill performance.

Area of Science:

  • Ophthalmology
  • Surgical Simulation
  • Cardiovascular Physiology

Background:

  • Cataract surgery simulation is crucial for surgical training.
  • Current virtual reality (VR) simulations may lack realistic operating room (OR) contextual elements.
  • The impact of immersive OR simulation on physiological and performance outcomes requires investigation.

Purpose of the Study:

  • To assess the influence of incorporating contextual OR elements into cataract surgery simulation on cardiovascular responses, subjective stress, and surgical performance.
  • To compare a high-fidelity (HiFi) simulation with a low-fidelity (LoFi) VR simulation and real surgery.

Main Methods:

  • A prospective, within-subject crossover study involving ten ophthalmic surgeons.
  • Surgeons performed cataract surgery simulations under three conditions: real surgery, LoFi VR simulation, and HiFi VR simulation with integrated OR elements.

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  • Cardiovascular responses (heart rate [HR], heart rate variability [HRV]), subjective stress, and technical performance were measured.

    • Main Results:

    • The HiFi simulation demonstrated significantly higher average and peak HR compared to LoFi, with a temporal HR pattern similar to real surgery.
    • No significant differences were found in HRV metrics or subjective stress ratings between HiFi and LoFi simulations.
    • Technical surgical performance remained comparable across all conditions.

    Conclusions:

    • Simulating cataract surgery in an immersive OR environment enhances cardiovascular activation, closely mimicking real surgical conditions.
    • This HiFi simulation approach effectively trains surgical skills without negatively impacting technical performance.
    • The findings support the use of high-fidelity simulation for developing both technical and nontechnical surgical skills in a controlled setting.