title: Clinical Efficacy of Simulated Vitreoretinal Surgery to Prepare Surgeons for the Upcoming Intervention in the Operating Room.
abstract: OBJECTIVE
  To evaluate the efficacy of the virtual reality training simulator Eyesi to prepare surgeons for performing pars plana vitrectomies and its potential to predict the surgeons' performance.
  
  
  METHODS
  In a preparation phase, four participating vitreoretinal surgeons performed repeated simulator training with predefined tasks. If a surgeon was assigned to perform a vitrectomy for the management of complex retinal detachment after a surgical break of at least 60 hours it was randomly decided whether a warmup training on the simulator was required (n = 9) or not (n = 12). Performance at the simulator was measured using the built-in scoring metrics. The surgical performance was determined by two blinded observers who analyzed the video-recorded interventions. One of them repeated the analysis to check for intra-observer consistency. The surgical performance of the interventions with and without simulator training was compared. In addition, for the surgeries with simulator training, the simulator performance was compared to the performance in the operating room.
  
  
  RESULTS
  Comparing each surgeon's performance with and without warmup trainingshowed a significant effect of warmup training onto the final outcome in the operating room. For the surgeries that were preceeded by the warmup procedure, the performance at the simulator was compared with the operating room performance. We found that there is a significant relation. The governing factor of low scores in the simulator were iatrogenic retinal holes, bleedings and lens damage. Surgeons who caused minor damage in the simulation also performed well in the operating room.
  
  
  CONCLUSIONS
  Despite the large variation of conditions, the effect of a warmup training as well as a relation between the performance at the simulator and in the operating room was found with statistical significance. Simulator training is able to serve as a warmup to increase the average performance.
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Deuchler
authors.affiliation: VRmagic, Mannheim, Baden-Württemberg, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Singh
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Müller
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.|King Abdullah University Hospital, Irbid, Jordan.
authors.forename: Rami
authors.initials: R
authors.lastname: Al-Dwairi
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Rachid
authors.initials: R
authors.lastname: Benjilali
authors.affiliation: VRmagic, Mannheim, Baden-Württemberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Schill
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, University Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.affiliation: Institute of Biostatistics and Mathematical Modelling, University Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Bon
authors.affiliation: University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kohnen
authors.affiliation: VRmagic, Mannheim, Baden-Württemberg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schoene
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.|University Eye Hospital, Heidelberg, Baden-Württemberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Koss
authors.affiliation: Vitreoretinal Unit, University Eye Hospital, Frankfurt/Main, Hessen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Koch
mesh_terms: D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D066231:Surgeons; D014584:User-Computer Interface; D014821:Vitrectomy