VIRTUAL REALITY

Virtual eye surgery with the EYEsi system allows surgeons in training to practise their surgical techniques free of anxiety and provides them with encouraging feedback as their skills improve, said Dušica Pahor MD, Faculty of Medicine, University of Maribor, Slovenia, Department of Ophthalmology, University Medical Centre Maribor, Slovenia

“The technical difficulties involved in modern ophthalmological procedures have increased the need to perform training outside the operating theatre. Surgeons must learn to control the psychological stress during surgery. Ophthalmic virtual reality simulators represent a satisfactory response to this need, she said at a symposium of the Slovenian Society of Ophthalmology, at the 18th ESCRS Winter Meeting in Ljubljana.

She noted that her department has adopted the VRMagic EYESi Ophthalmic Surgical Simulator for surgical training purposes. The device is one of the most well-developed simulators available and provides trainee surgeons with repeated measurements of standardised surgical tasks performed in a virtual environment. It also provides feedback on the achievement of surgical goals, surgical efficiency and surgical errors.

The simulator consists of a mannequin head with a rotatable electronic eye. It also includes a virtual operating microscope, complete with zoom/focus foot pedal, that provides stereoscopic images of the eye and instruments to the surgeon.

To use the device the trainee surgeon first logs in and configures the settings for the eye and instrumentation on a touch screen control panel. When performing a virtual procedure, the surgeon inserts a special set of hand-held instruments into the electronic eye. The device simulates instrument interaction with the ocular tissues and ocular structures, which the trainee can observe through the virtual microscope.

There is a range of training modules available for the EYESi simulator. The modules range in difficulty from the relatively simple to very complicated tasks. It also allows the surgeon to practise each part of a procedure in isolation until they have fully mastered it. There are courses on capsulorhexis, hydrodissection and phacoemulsification. “Each course combines training of basic skills with training of actual surgical procedures in structured course design, leading students step-by-step to expert performance,” Dr Pahor said.

The modules have a game-type structure. An example is the anterior segment forceps module. It requires the surgeon to grasp objects from an area in the periphery of the anterior chamber and place them in a basket in a different place in the anterior chamber. As the training progresses, the surgeon moves to new levels where the task becomes increasingly difficult. “This task is for teaching the surgeon the skills required to grasp the edge of a capsulorhexis flap, keeping the eye centred and avoiding injury to the lens or cornea,” Dr Pahor said.

For each attempt the surgeon makes the score can vary from zero to 100. The simulator gives points for the percentage of the task completed, but subtracts points for reduced efficiency and errors such as excessive time taken and injuries to intraocular structures and tissues.

Simulation technology should become a standard feature of ophthalmic surgical training programmes, Dr Pahor said. It can improve patient safety for surgical procedures such as vitreoretinal and cataract surgery in modern surgical education.

“Virtual reality simulation offers a new approach for surgical training. Results of previous studies revealed a positive transfer of skills from the simulation environment to initial operating room procedures,” she said.

She added that a structured curriculum with a virtual reality training programme teaching the basic skills should be the first step in a procedure-based training curriculum for ophthalmic surgery.

“A standardised approach to surgical training is needed. Only with an integrated approach can we move from the old model of practising on real patients. Virtual reality simulation can be made available to trainees any time and any place and does not require any additional supplies or animal tissue. It is the ideal training tool,” Dr Pahor concluded.

Dušica Pahor: d.pahor@ukc-mb.si