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First Author: DusicaPahor SLOVENIA
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Technical difficulties of ophthalmological procedures have increased the need to perform training outside the operating theatre. Surgeons must control the psychological stress during surgery. Ophthalmic virtual reality (VR) simulators represent a satisfactory response to this request. Unfortunately the application is limited because of high costs. Modern equipment at our department with complete today available ophthalmic VR simulators (VRMagic EYESi Ophthalmic Surgical Simulator, Mannheim, Germany) including EYESi Indirekt Ophthalmoscope Simulator, EyeSi vitreoretinal and EyeSi cataract simulators, gave us a completely new opportunity to include several novel aspects of ophthalmic simulation in residents education.
: Faculty of Medicine, University of Maribor, Slovenia, Department of Ophthalmology, University Medical Centre Maribor, Slovenia
EYESi Surgical was originally designed as a vitroretinal training device. After some time an anterior segment module was developed for cataract surgery training as well as EYESi indirect and direct simulator. VRMagic EYESi ophthalmic surgical simulator allows repeated measurements of standardized surgical tasks. Feedback is provided in the surgical goal, surgeon efficiency, achievement of surgical goal, surgeon error or tissue injury and formative education feedback. Simulator consists of mannequin head with an electronic eye that rotates when manipulated by the surgeon. The simulation system is controlled by means of the touch screen. After login, the instruments can be configured and the courses selected and started. Original handheld instruments are inserted into the electronic eye and are freely movable. Instrument interaction with tissue and ocular structure is simulated in real time. A virtual operating microscope complete with zoom/focus foot pedal provides stereoscopic images of the eye and instruments to the surgeon. Each module has different difficulty levels to simulate increasingly complicated tasks. Required surgical skills can be isolated and train separately until they have been fully mastered. 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.
The platform of cataract training module is equipment with cataract eye interface, a cataract instrument set and foot pedals. Capsulorhexis, hydrodisection and phaco with different setting can be used. The approach is step by step. The number of cataract training modules can be upgraded when new modul is available. The anterior segment forceps module requires the surgeon to grasp six objects from the periphery of the anterior chamber and place them in a basket in the anterior chamber. The size, shape and anteroposterior location of the object within the anterior chamber vary according to the model's difficulty level, ranging from 1 to 4. 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. For each attempt the total possible score can vary from 0 to 100. The simulator provides positive points for the percentage of the task completed. For reduced efficiency and errors such as excessive time taken, corneal injuries, lens injuries, distance travelled by the instruments within the anterior chamber, operating without red reflex, non-horizontal insertion of the instrument and out-of-focus interaction points are subtracted.
VR simulation offers a new approach for surgical training. VRMagic EYESi Ophthalmosurgical Simulator is one of the well-developed simulators availably currently. Results of previous studies revealed positive transfer from the simulation environment to initial operating room procedures. Simulation technology must be used to improve patient safety for surgical procedures such as vitreoretinal and cataract surgery in modern surgical education. The structured curriculum including the VR training program must be added to the residence education program. A procedure-based training curriculum for ophthalmic surgery must begun by teaching the basic skills, such as hand-eye coordination, depth perception, anti tremor program, etc. A standardized approach to surgical training is needed. Only with integrated approach it will be possible to deviate from the old model of practising on real patients. VR simulation can be made available to trainees anytime and anyplace and does not required any additional supplies or animal tissue. It is the ideal training tool. Department of Ophthalmology, Faculty of Medicine in Maribor offers a new opportunity to perform a new modern concept of surgical education in this part of Europe for Alps-Adria countries with organization of a multifaceted training programme in the future. FINANCIAL INTEREST: NONE