# Acclimatising with 3D virtual reality video improves simulator performance: initial findings of a randomised controlled feasibility trial

## TL;DR

Using 3D virtual reality video improves robotic surgery simulator performance for beginners compared to 2D video.

## Contribution

This study shows that acclimating to 3D VR video improves robotic surgery simulator performance in novices.

## Key findings

- The 3D VR group had significantly better performance in all primary metrics compared to the 2D group.
- The 3D VR group had shorter instrument path lengths and fewer penalty scores.
- Only 21.4% of the 3D VR group reported mild, transient cybersickness symptoms.

## Abstract

The transition from traditional laparoscopy to robotic surgery marks a significant chage in surgical practice. An understated aspect of this transition may be the three dimensional (3D) view from the surgical console. This study hypothesises that acclimatisation with 3D virtual reality (VR) video may enhance robotic simulator performance in novice robotic surgeons.

This feasibility randomised controlled trial (RCT) involved 18 participants, randomly assigned to either a 3D VR video group or a 2D video group. The 3D group viewed a procedural video on a VR headset, while the 2D group watched the same video on a standard laptop screen. Participants then performed the initial 4 introductory robotic simulator exercises. Primary outcomes included automated performance metrics (APMs) including instrument path length, completion time, penalty scores, and overall performance score. Secondary outcomes were perceived mental workload using the NASA Task Load Index (NASA TLX) and cybersickness rates.

The 3D VR group demonstrated significantly better performance across all primary outcome measures. Mean overall performance scores for 3D VR was 52.75, compared to 29.78 for 2D (p < 0.01) Mean instrument path length for the 3D VR group was 305.09 cm, compared to 413.72 cm for the 2D group (p < 0.01) The 3D VR group incurred fewer penalty scores, with a mean of -8.16 compared to—23.99 for the 2D group (p = 0.03). 3 participants (21.4%) reported mild cybersickness symptoms with VR, which were transient. No significant differences were observed in perceived mental workload between the groups.

Acclimatisation with 3D VR video significantly enhances simulator performance among novice robotic surgeons, suggesting its potential integration into standard robotic surgery training protocols. Further studies with larger sample sizes and clinical settings are warranted to confirm these findings.