Abstract
To validate the capability of AR in surgical training.
Design
We utilised objective and subjective assessment through various prospective cohort studies, health economics evaluation and a systematic review (SR) of available literature satisfying all Kirkpatrick levels of evidence.
Setting
Within the National Health Service of the United Kingdom.
Patients or Participants
Junior surgical trainees (residents).
Interventions
Simulation training.
Measurements and Main Results
Initially an independent SR was conducted (n=26) comparing AR vs incumbent modalities (VR, box trainers, & cadaveric). We demonstrated that AR is preferred, improves procedural success and provides faster skill acquisition when compared to other modalities.
Several pilot studies were then conducted utilising the LapAR1. One (n=11) demonstrated through benchmarks of either appendicectomies (n=5) or vaginal vault (n=6) closures that intervening AR-based training under one hour with LapPass2 tasks significantly improved ‘completion time’ by 19% and 36.9%, and ‘distance travelled(m)’ by 25% and 56% respectively. Another (n=6) demonstrated through 10 appendicectomy benchmarks with three intervening LapPass tasks over the course of two weeks, significant savings in ‘completion time’ by 55-66% and ‘distance travelled’ by 39-72%. Finally, another study looking at self-confidence scores pre and post-LapAR exercises indicated that a mean improvement of 3.82 (likert, p=0.018) was found across all areas.
Finally, a BMJ peer-reviewed health economics review3 found that £79 could be saved per appendicectomy patient. Once validation of the efficiency assumptions were made using the study data, we can extrapolate and realise a potential cost saving of £455 per patient through reduced anaesthetic time and shorter inpatient stay.
Conclusion
We can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential new gold standard.