Table 4 Study descriptions
| Population | Methodology | |||||
|---|---|---|---|---|---|---|
| Study | No. of participants | VR-simulated task simulator | Control Task | Assessment | Outcome Measures | Results |
| Andersen et al. [13] | 21 (14 novices, 7 experts) | Visualise, palpating spheres on anatomical landmarks in the shoulder | No additional training | Visualise, palpating spheres on anatomical landmarks in VR | Time to complete exercise, number of collisions, maximum depth of collision, paths travelled by camera and probe | SS reduction in time (p = 0.03), path distance (p = 0.02) and depth of collisions (p = 0.02) for VR group. Number of collisions not SS in difference (p = 0.07). |
| Banaszek et al. [18] | 40 (all novices) | Perform diagnostic knee arthroscopy and probing examination |
Control 1: perform simulated task on benchtop simulator Control 2: no additional training | Perform diagnostic arthroscopy on both simulators and cadaver, perform medial meniscectomy on cadaver | GRS scores, procedure-specific checklist, time per task, motion analysis | Both simulator groups showed improvement compared to control in all outcomes. VR group performed SS better than benchtop in lab and on cadaver (p = 0.02). |
| Blumstein et al. [25] | 17 (all novices) | Perform tibial shaft fracture IM nailing | Read printed instructions on surgical technique for procedure | Perform tibial shaft fracture IM nailing on benchtop model | GRS and procedure-specific checklist | SS higher GRS (p = 0.001) and increase in correctly completed steps (p = 0.008) in VR group. |
| Cannon et al. [19] | 48 (all intermediates) | Visualise, probe anatomical structures in the knee (must achieve level of proficiency to progress) | No additional training | Perform diagnostic arthroscopy on live patient, within 25 min | GRS, procedure-specific checklist (visualisation scale and probing scale) | VR group had SS higher scores in procedure-specific checklist (p = 0.031), but not GRS (p = 0.061). Visualisation score did not have SS difference (p = 0.34). Control group was faster but performed less correct steps. |
| Cychosz et al. [20] | 43 (all novices) | Complete FAST modules on tracking, periscoping, palpation and collecting stars. Perform knee arthroscopy | No additional training | Perform diagnostic knee arthroscopy in VR | Camera path length, cartilage damage, time to complete | VR group had SS higher overall scores (p = 0.046) and shorter path length (0.0274). Time and damage not SS in difference (p = 0.3, p = 0.4). VR group showed greater level of improvement pre- and post-test. |
| Gasco et al. [22] | 26 (all novices) | Place 2 pedicle screws | Didactic lecture on surgical technique for procedure | Place 2 pedicle screws in benchtop model | Screw placement, choice of screw, pedicle breaches | SS less errors in all outcomes for VR group (more than 50% reduction in placement error (p < 0.001)) |
| Henn et al. [14] | 17 (all novices) | Touch 11 targets in the shoulder | No additional training | Probe-specific points within shoulder on cadaver | GOALS score (time to complete, dexterity, depth perception, efficiency, respect for tissue) | SS reduction in time for VR group (p < 0.05), with SS improvement from baseline (p < 0.05). Improvement in GOALS score was greater than control, but not SS (p = 0.98) |
| Hooper et al. [28] | 14 (all novices) | Perform 2 simulated THAs | No additional training | Perform THA on cadaver | THA score, GRS | VR group showed greater improvement from baseline in all outcomes; however, this was not SS (p = 0.078). Only technical performance was SS (p = 0.009) |
| Hou et al. [23] | 10 (all novices) | Perform pedicle screw placement | Didactic lecture and video on surgical technique for procedure | Perform cervical pedicle screw placement on cadaver | Screw placement | SS higher ‘acceptable’ screw placement in VR group (100% vs 50% in control group, p = <0.05). SS higher ‘ideal’ screw placements for VR group (p = <0.05) |
| Lohre et al. [15] | 26 (19 intermediates, 7 experts) | Complete module outlining key steps in glenoid exposure procedure | Read technical article outlining steps of procedure | Perform glenoid exposure on cadaver | Time to complete, OSATS, completion of procedure-specific checklist | SS reduction in time for VR group (p = 0.04). Improvement in OSATS score, however only SS improvement over control in instrument handling (p = 0.03) |
| Middleton et al. [21] | 17 (all novices) | Visualisation, probing of anatomical structures within the knee | Visualisation, probing of anatomical structures within the knee on benchtop simulator | All groups perform visualisation and probing of anatomical structures within the knee on both benchtop and VR simulators | Motion analysis (total time taken and number of hand movements), GRS | Both groups improved from baseline (p = <0.05). Control group showed SS improvement on VR test (p = <0.05), but VR group did not show SS improvement on benchtop test (p= > 0.05). VR group did not consistently outperform control group on VR test. |
| Pahuta et al. [26] | 48 (all novices) | Drawing of both column hemipelvis fracture lines |
Control 1: draw fracture lines on benchtop model Control 2: read article on fracture carving, view 3D CT images | Drawing of both column hemipelvis fracture lines on surgically arranged benchtop hemipelvis, in 5 min | Accuracy of drawn fracture lines against known anatomical features of both-column fractures | VR group performed SS better than both control groups (p = 0.0001, p = 0.0026); lines were more accurate and had correct spatial relationships. No SS difference between control groups. |
| Rebolledo et al. [16] | 14 (all novices) | Probing of spheres on anatomical landmarks in the knee and shoulder | 2 h of didactic lectures on surgical technique | Perform standard diagnostic arthroscopy on knee and shoulder cadaver model | Time to complete, generated injury grading index (dexterity, collisions, injury to tissue) | SS reduction in time (p = 0.02) and injury grading index (p = 0.01) for VR group in shoulder exercises. VR group performed better than control in knee exercises, but differences were not SS (p = 0.09, p = 0.08) |
| Sugand et al. [27] | 52 (all intermediates) | Perform fixation of intertrochanteric fracture, 5x a week for 2 weeks | Perform fixation of intertrochanteric fracture, 1x a week for 2 weeks | Perform fixation of intertrochanteric fracture in VR | Time to complete, total fluoroscopy time, number of attempts to place guidewire, GRS | VR group performed better than control with SS in all outcomes (p = <0.001). VR also showed greater improvement from baseline than control. |
| Waterman et al. [17] | 22 (all intermediates) | Location of spheres in anatomical locations in shoulder, palpation of spheres | No additional training | Perform shoulder arthroscopy on live patient | Time to complete, camera distance, probe distance, ASSET | VR group had SS improvement from baseline (p = 0.01). VR group was SS faster than control (p = 0.01). ASSET score and camera distance were better the VR group, however without SS (p = 0.061, p = 0.070). |
| Xin et al. [24] | 16 (all intermediates) | Perform pedicle screw placement | Watch demonstration of correct nail placement and technique on 3D-printed model. | Placement of 6 pedicle screws T11-L4 on cadaver | Time for each screw, position of screw | SS higher ‘acceptable’ screw placement in VR group (100% vs 79.2% in control group, p = <0.05). SS higher ‘ideal’ screw placements for VR group (p = <0.05). SS reduction in time for VR group (p = <0.05). |