Virtual reality tools for training in gastrointestinal endoscopy:A systematic review

BACKGROUND Virtual reality(VR)has emerged as an innovative technology in endoscopy training,providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills.This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods.AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods.By examining the current state of the field,this review seeks to identify gaps,challenges,and opportunities for further research and implementation of VR in endoscopic training.METHODS The study is a systematic review,following the guidelines for reporting systematic reviews set out by the PRISMA statement.A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available,from electronic databases such as PubMed,Scopus,Cochrane,and Google Scholar.The results were systematically reviewed.RESULTS Sixteen articles were included in the final analysis.The total number of participants was 523.Five studies focused on both upper endoscopy and colonoscopy training,two on upper endoscopy training only,eight on colonoscopy training only,and one on sigmoidoscopy training only.Gastrointestinal Mentor virtual endoscopy simulator was commonly used.Fifteen reported positive results,indicating that VR-based training was feasible and acceptable for endoscopy learners.VR technology helped the trainees enhance their skills in manipulating the endoscope,reducing the procedure time or increasing the technical accuracy,in VR scenarios and real patients.Some studies show that the patient discomfort level decreased significantly.However,some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups.CONCLUSION VR training is effective for endoscopy training.There are several well-designed randomized controlled trials with large sample sizes,proving the potential of this innovative tool.Thus,VR should be more widely adopted in endoscopy training.Furthermore,combining VR training with conventional methods could be a promising approach that should be implemented in training.

Towards engineering a portable platform for laparoscopic pre-training in virtual reality with haptic feedback

Background Laparoscopic surgery is a surgical technique in which special instruments are inserted through small incision holes inside the body.For some time,efforts have been made to improve surgical pre training through practical exercises on abstracted and reduced models.Methods The authors strive for a portable,easy to use and cost-effective Virtual Reality-based(VR)laparoscopic pre-training platform and therefore address the question of how such a system has to be designed to achieve the quality of today's gold standard using real tissue specimens.Current VR controllers are limited regarding haptic feedback.Since haptic feedback is necessary or at least beneficial for laparoscopic surgery training,the platform to be developed consists of a newly designed prototype laparoscopic VR controller with haptic feedback,a commercially available head-mounted display,a VR environment for simulating a laparoscopic surgery,and a training concept.Results To take full advantage of benefits such as repeatability and cost-effectiveness of VR-based training,the system shall not require a tissue sample for haptic feedback.It is currently calculated and visually displayed to the user in the VR environment.On the prototype controller,a first axis was provided with perceptible feedback for test purposes.Two of the prototype VR controllers can be combined to simulate a typical both-handed use case,e.g.,laparoscopic suturing.A Unity based VR prototype allows the execution of simple standard pre-trainings.Conclusions The first prototype enables full operation of a virtual laparoscopic instrument in VR.In addition,the simulation can compute simple interaction forces.Major challenges lie in a realistic real-time tissue simulation and calculation of forces for the haptic feedback.Mechanical weaknesses were identified in the first hardware prototype,which will be improved in subsequent versions.All degrees of freedom of the controller are to be provided with haptic feedback.To make forces tangible in the simulation,characteristic values need to be determined using real tissue samples.The system has yet to be validated by cross-comparing real and VR haptics with surgeons.

Academic Stress Assessment Using Virtual Reality as an Educational Tool in Spine Surgery

Introduction: The evaluation of academic stress in medical students and residents is a topic of significant interest, given the considerable challenges they face during their learning process with traditional teaching methods. The use of technologies like virtual reality presents an opportunity to enhance their skills through simulations and training. The main objective of this study is to qualitatively assess the stress levels experienced by medical students and residents by integrating virtual reality into their current learning methods, aiming to improve their ability to manage stressors in their practice. Material and Methods: A questionnaire was conducted with 12 medical students and 12 Traumatology and orthopedics residents. The purpose of the questionnaire was to evaluate the levels of academic stress using the SISCO inventory. The stress levels were calculated by transforming average values into percentages, and the following criteria were assigned: 0 to 33% for Mild Stress, 34 to 66% for Moderate Stress, and 67 to 100% for Deep Stress. Then, a virtual reality class focused on spine surgery was provided. Both medical students and residents were trained using the Non Nocere SharpSurgeon software platform and Oculus Quest 2 virtual reality glasses. At the end of the session, a second questionnaire related to the practice with virtual reality was conducted with the same evaluation criteria and a comparative analysis was carried out. Results: 12 undergraduate students from Hospital Angeles Mexico, CDMX and 12 traumatology and orthopedics residents at Hospital Santa Fe, Bogota were evaluated. The students in CDMX reported an average qualitative stress of 28.50% during habitual practices, which decreased to an average of 14.67% after virtual reality practice. Residents in Bogotá experienced an average qualitative stress of 30.50% with their current learning methods but this reduced to an average of 13.92% after using virtual reality. These findings indicate that the use of virtual reality has a positive impact on reducing stress levels qualitatively. Conclusions: The use of virtual reality as a learning method for medical students and residents qualitatively improves stress levels. Further studies are required to define the potential uses of Virtual Reality to improve learning methods and emotional state in medical students and residents and for a quantitative assessment to validate the training as certified learning methods.

Head-mounted display-based intuitive virtual reality training system for the mining industry

Virtual reality(VR) training technology in the mining industry is a new field of research and utilization.The successful application of VR training system is critical to mine safety and production. Through the statistics of the current research and applications of VR training systems in mining industry, all the input/output devices are classified. Based on the classifications of the input/output devices that are used in the VR system, the current VR training systems for the mining industry could be divided into three types: screen-based general type, projector-based customized type, and head-mounted display(HMD)-based intuitive type. By employing a VR headset, a smartphone and a leap motion device, an HMDbased intuitive type VR training system prototype for drilling in underground mines has been developed.Ten trainees tried both the HMD-based intuitive system and the screen-based general control system to compare the experiences and training effects. The results show that the HMD-based system can give a much better user experience and is easy to use. Three of the five components of a VR training system,namely, the user, the tasks, and software and database should be given more attention in future research.With more available technologies of input and output devices, VR engines, and system software, the VR training system will eventually yield much better training results, and will play a more important role in as a training tool for mine safety.

Virtual reality simulation in training endoscopic skills: A systematic review

Objective:Training young physicians in gastrointestinal endoscopy through virtual reality(VR)simulators has become popular.It is important to evaluate the benefits and usefulness of this technology for teaching endoscopic skills.The objective of this literature review is to understand the benefits of VR technology through quantitative and qualitative examination of learning outcomes.Methods:A literature search of 7 databases was conducted.Studies which compared the effects of learning through VR simulation and another method of learning were included.In addition,studies were included if they evaluated learning outcomes on clinical patients.Participants could be medical residents,fellows,physicians,or nurses.Common outcomes measured across studies included subjective overall performance scores,total procedure times,rate of successful procedure completion,error rates,patient pain or discomfort,and measures of independence.Results:A total of 22 studies were included.Overall,VR simulation training was seen to be comparable or significantly better than clinical training,no training,other types of simulation,and another form of VR training.Many authors reported increasing patient safety,reducing stress and time constraints,and shortening the learning curve as advantages of VR simulation training.However,this form of training is also expensive and may result in the learning of bad habits.Conclusion:VR simulation technology can be a valuable form of educating endoscopy novices if properly supervised during training,and if there is also integration of clinical training.

Development of a plastic injection molding training system using Petri nets and virtual reality

In this study, Virtual Reality (VR)-based plastic injection molding training system (VPIMTS), which can be modeled as an integrated system with a task planning module, an intelligent instruction module, a simulation module, and virtual envi-ronment (VE) module, was developed. Presented in this paper are an architecture of VPIMTS, a practical knowledge modelling approach for modelling the training scenarios of the system by using Petri nets formalism and key techniques (FEM, injection molding procedure modelling) which have been developed independently. The utilization of the Petri net model realized the environment where the trainee can behave freely, and also made it possible to equip the system with the function of showing the next action of the trainee whenever he wants. The overall system is a powerful approach for highly improving the trainee’s comprehension and injection molding study-efficiency by building digital, intelligent, knowledgeable, and visual aids.

Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains un- clear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The FugI-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sen- sorimotor cortex.

Virtual reality for immersive multi-user firefighter-training scenarios

Background Virtual reality(VR)applications can be used to provide comprehensive training scenarios that are difficult or impossible to represent in physical configurations.This includes team training for emergency services such as firefighting.Creating a high level of immersion is essential for achieving effective virtual training.In this respect,motion-capture systems offer the possibility of creating highly immersive multi-user training experiences,including full-body avatars.Methods This study presents a preliminary prototype that helps extin-guish a virtual fire on a container ship as a VR training scenario.The prototype provides a full-body and multi-user VR experience based on the synthesis of position data provided by the motion-capture system and orientation data from the VR headsets.Moreover,the prototype facilitates an initial evaluation of the results.Results The results confirm the value of using VR for training procedures that are difficult to implement in the real world.Furthermore,the results show that motion-capture-based VR technologies are particularly useful for firefighting training,in which participants can collaborate in difficult-to-access environments.However,this study also indicates that increasing the immersion in such training remains a challenge.Conclusions This study presents a prototypical VR application that enables the multi-user training of maritime firefighters.Future research should evaluate the initial results,provide more extensive training scenarios,and measure the training progress.

Multimodal teaching,learning and training in virtual reality:a review and case study

It is becoming increasingly prevalent in digital learning research to encompass an array of different meanings,spaces,processes,and teaching strategies for discerning a global perspective on constructing the student learning experience.Multimodality is an emergent phenomenon that may influence how digital learning is designed,especially when employed in highly interactive and immersive learning environments such as Virtual Reality(VR).VR environments may aid students'efforts to be active learners through consciously attending to,and reflecting on,critique leveraging reflexivity and novel meaning-making most likely to lead to a conceptual change.This paper employs eleven industrial case-studies to highlight the application of multimodal VR-based teaching and training as a pedagogically rich strategy that may be designed,mapped and visualized through distinct VR-design elements and features.The outcomes of the use cases contribute to discern in-VR multimodal teaching as an emerging discourse that couples system design-based paradigms with embodied,situated and reflective praxis in spatial,emotional and temporal VR learning environments.

A virtual reality based surgical skills training simulator for catheter ablation with real-time and robust interaction

Background Atrial fibrillation(AF)is the most common sustained cardiac arrhythmia that can cause severe heart problems.Catheter ablation is one of the most ideal procedures for the treatment of AF.Physicians qualified to perform this procedure need to be highly skilled in manipulating the relevant surgical devices.This study proposes an interactive surgical simulator with high fidelity to facilitate efficient training and low-cost medical education.Methods We used a shared centerline model to simulate the interaction between multiple surgical devices.An improved adaptive deviation-feedback approach is proposed to accelerate the convergence of each iteration.The periodical beating of the human heart was also simulated in real time using the position-based dynamics(PBD)framework to achieve higher fidelity.We then present a novel method for handling the interaction between the devices and the beating heart mesh model.Experiments were conducted in a homemade simulator prototype to evaluate the robustness,performance,and flexibility of the proposed method.Preliminary evaluation of the simulator was performed by medical students,residents,and surgeons.Results The interaction between surgical devices,static vascular meshes,and beating heart mesh was stably simulated in a frame rate suitable for interaction.Conclusion Our simulator is capable of simulating the procedure of catheter ablation with high fidelity and provides immersive visual experiences and haptic feedback.

The application of virtual reality training for anastomosis during robot-assisted radical prostatectomy

Objective:To investigate the application of virtual reality training in vesicourethral anastomosis during robot-assisted radical prostatectomy(RARP).Methods:Three certified robotic urologists who underwent virtual reality training were enrolled in the study group.The other three without training were enrolled in the control group.Parameters were recorded before and after the training.Then a total of 18 patients undergoing RARP were enrolled and randomized assigned to receive anastomosis procedures with certified urologists who either obtained or did not obtain training.The quality of the anastomosis was evaluated.Results:For the virtual training evaluation,the overall score was significantly improved from 65.0±10.8 to 92.7±3.5(p=0.014);the time of anastomosis was shortened;the economy of motion improved;instrument collisions decreased after training(p<0.05).Besides,the effectiveness of the virtual training was evaluated in the 18 real anastomosis procedures which were completed either by three urologists with training or three urologists without training.Most intriguingly,the average time of anastomosis was shortened from 40.0±12.4 min to 25.1±7.1 min(p=0.015).The parameters including time of operation,creatinine level of drainage,postoperative hospital stay and duration of catheter drainage were comparable before and after training.Two leakages,which were observed in procedures by doctors without training,needed salvage sutures by a senior doctor.Conclusions:Virtual reality training enabled surgeons to become quickly familiar with robotic system manipulation,improved their skills for vesicourethral anastomosis and shortened the learning curve,thus helping them operate with high efficacy and quality.

Gamification and virtual reality for digital twin learning and training:architecture and challenges

Background Digital Twins are becoming increasingly popular in a variety of industries to manage complex systems.As digital twins become more sophisticated,there is an increased need for effective training and learning systems.Teachers,project leaders,and tool vendors encounter challenges while teaching and training their students,co-workers,and users.Methods In this study,we propose a new method for training users in using digital twins by proposing a gamified and virtual environment.We present an overall architecture and discuss its practical realization.Results We propose a set of future challenges that we consider critical to enabling a more effective learning/training approach.

Virtual reality in residents training

Training in residency programs is highly competitive,it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills,attitudes and interpersonal abilities.The use of simulation and technology on the medical education has increased considerably.Particularly in ophthalmology the simulators used are:live models from animal or cadavers,mannequins,wet laboratories,simulated patients,part-task moles,laser or surgical models,and more recently,virtual reality(VR).VR places a person in a simulated environment that has a specific sense of self-location,where the participant interacts with the objects within the setting.Teaching with VR refers to the use of the available resources in technology and visualization of structures to improve the educational experience of medical students,residents and physicians in professional continuous development programs.Several authors highlight the benefits of assessing trainees with the tools,they argue that the key contribution of this model is in the formative assessment.Rather than evaluating and putting a score on student’s grades,VR provides a powerful experience for the acquisition of skills.A conclusion is the need to develop studies to document the effects that it has on knowledge,skills and behaviors,and to patient related outcomes.

Validity of virtual reality simulator in training of transurethral resection of prostate

Objective To assess the face and construct validity of a full procedural transurethral prostate resection simulator ( TURPSimTM ) in training of transurethral resection of prostate. Methods Ten experienced and thirteen inexperienced urologists ( TURP experience ≥ 30 and

Assessing performance of augmented reality-based neurosurgical training

This paper presents a novel augmented reality(AR)-based neurosurgical training simulator which provides a very natural way for surgeons to learn neurosurgical skills.Surgical simulation with bimanual haptic interaction is integrated in this work to provide a simulated environment for users to achieve holographic guidance for pre-operative training.To achieve the AR guidance,the simulator should precisely overlay the 3D anatomical information of the hidden target organs in the patients in real surgery.In this regard,the patient-specific anatomy structures are reconstructed from segmented brain magnetic resonance imaging.We propose a registration method for precise mapping of the virtual and real information.In addition,the simulator provides bimanual haptic interaction in a holographic environment to mimic real brain tumor resection.In this study,we conduct AR-based guidance validation and a user study on the developed simulator,which demonstrate the high accuracy of our AR-based neurosurgery simulator,as well as the AR guidance mode’s potential to improve neurosurgery by simplifying the operation,reducing the difficulty of the operation,shortening the operation time,and increasing the precision of the operation.

New-Level VR Marine Training System

Marine simulator is a valuable and effective medium for maritime education and training and is becoming widespread to foster the qualified and competent personnel for working in the maritime industry. However, many problems with most marine simulation systems today limit their pervasive use: the limited accessibility, immobility, the high expenditure, the long development cycle, and the difficult maintenance etc. A web-based maritime training environment is proposed in this paper as a new marine training level, which fully combining web technology, VR, high fidelity simulation, and e-learning tools to create a more costeffective and flexible training environment still with very realistic and high-interactive simulation characteristics, the system will provide a consistent and more flexible training medium for improving maritime education and training.

虚拟现实技术在成人心肺复苏培训中应用的范围综述

目的对虚拟现实(virtual reality,VR)技术在成人心肺复苏(cardiopulmonary resuscitation,CPR)培训中的应用进行范围审查,以识别VR技术干预的内容要素和应用效果。方法以乔安娜布里格斯研究所范围综述指南为方法学框架,检索PubMed、Embase、CINAHL、Web of Science、Cochrane Library、中国知网、万方和中国生物医学文献数据库,检索时限为建库至2023年8月31日,对纳入文献进行汇总和分析。结果共纳入15篇文献,VR技术干预的内容要素包括实施CPR的意愿、反应、自我效能、按压频率、按压深度、无血流时间、复训时间、时间成本;结局指标类型为心理指标、胸外按压的质量指标、经济指标。结论VR技术在成人CPR培训中具有良好的应用前景,在心理、胸外按压质量、经济等方面的效果还可进一步挖掘。未来可基于面对面培训联合数字化反馈装置,最大化发挥VR技术的优势,形成一套综合干预策略和创新的培训模式,以进一步提高CPR培训的整体成效。

VR技术联合CBL教学在急诊住院医师规范化培训教学中的探索应用

目的 探讨虚拟现实(VR)技术联合基于案例的学习(CBL)在急诊教学中的应用效果。方法 选取2020年9月至2022年9月台州市第一人民医院40例规范化培训医师作为研究对象,采用随机数字表法将其分为实验组和传统组,每组20名。传统组采用情景模拟+讲授式教学,实验组采用VR技术联合CBL教学。比较两组理论、技能成绩及教学满意度的差异。结果 培训后,实验组学员的理论及操作考试成绩均高于传统组,差异均有统计学意义(t分别=2.58、2.38,P均<0.05)。在学习的主动性、培训模式的新颖性、提升学习效率、提升理论知识的理解、提升临床技能、加强临床思维、培训总体的满意度方面,实验组的教学满意度均高于传统组,差异均有统计学意义(t分别=3.13、3.33、2.25、2.73、2.27、2.37、2.96,P均<0.05)。实验组学员对VR课程的评分明显高于持中立态度的分值,差异有统计学意义(t=23.17,P<0.05)。结论 VR技术联合CBL教学法在急诊住院医师规范化培训教学中可以取得良好的教学效果和教学满意度,为医学教育提供了新的方法和途径。