Evaluation of the OPTESK VR training simulator for gastric bleeding treatment

Bleeding in the upper gastrointestinal tract is a common and potentially life-threatening emergency that requires rapid and highly precise endoscopic intervention. As supervised hands-on training is limited and often restricted to living animal models, an immersive virtual reality (VR) simulation offers a risk-free and accessible alternative.

A novel open-source VR training simulator, OPTESK, was developed for the treatment of upper gastrointestinal (GI) bleeding. The system consists of a combination of conventional endoscopes used in routine clinical practice, which can be operated in conjunction with commercially available head-mounted displays and the in-house developed OPTESK hardware. The simulator covers two scenarios: the treatment of a non-bleeding angiodysplasia with argon plasma coagulation (APC) and the treatment of a bleeding angiodysplasia starting with the injection of adrenaline followed by APC therapy. The simulator was evaluated in a multicenter user study in terms of workload, usability, immersion, cybersickness, and face, content, and construct validity. User performance was assessed via scores on time, amount of treated area, and correctly applied APC intensity.

In total, 44 participants from more than 20 centers were included in the study. Successful hemostatic control in the second scenario was achieved by 97.4% of the participants. Regarding the content validity, participants rated the helpfulness of the simulator for training the management of bleeding with a median of 4 on a scale from 1 (strongly disagree) to 5 (strongly agree). Mean perceived workload (NASA-TLX) and usability (SUS) were rated with 34.2/100 and 69.6/100 respectively. Face validity questions regarding the realism of endoscope movement, stomach anatomy, and application of APC were further rated with a median of 4 on the scale from 1 to 5. Regarding construct validity, gastroscopy experience showed significantly faster treatment of bleeding related tasks for both scenario one (p = .008) and two (p = .011) compared to participants with less gastroscopy experience.

OPTESK can serve as a valuable training tool for endoscopic treatment of bleeding in the upper GI tract. This approach may help reduce dependence on animal-based training and enable risk-free practice prior to clinical intervention.