Advantages and disadvantages of using immersive technologies in surgical training

The integration of new teaching technologies such as VR in surgical education has brought about numerous advantages (Table 5.), enhancing the learning experience for aspiring surgeons and contributing to advancements in medical training. It enables students to acquire the necessary skills in a setting that doesn’t compromise the safety of patients while also maximizing their learning potential [1] and this stands as the utmost benefit, valuable for both educators, students, and the patients themselves. Educators are able to create a wide range of scenarios, including rare and complex cases, enhancing the depth and breadth of surgical education. They have also opportunity to evaluate trainee’s performance, provide targeted feedback, monitor and facilitate improvement. Furthermore, virtual simulations enables remote access to surgical education, expanding its reach to a global audience and overcoming geographical limitations [2].

At the same time trainees gain realistic practical skills, with variety of surgical scenarios, preparing them for a wide range of situations in their careers. Simulation allows them to make mistakes, learn from them, and refine their skills. Trainees can engage in repetitive practice, fostering the development of muscle memory and improving overall proficiency in surgical techniques [3, 4] They receive instant feedback on their performance, helping them identify areas for improvement. They progress personally at their own pace, reinforcing skills before moving on to more advanced procedures.

The essential advantage for patients is safety. Simulation and VR contribute to better-trained practitioners, potentially leading to improved surgical outcomes. It was shown, that extensive simulation training, minimizes the risk of errors, reduces operating time lowering the length of anesthetic events during actual procedures in different types of surgery. Skills learned using VR simulation are transferable to the operation room [5]. Exceptional outcomes were realized in the field of laparoscopic and robotic surgery, where, even in real cases there is a lack of tactile senses and the need to navigate in a 3D environment visualized on a 2D screen. Despite the advantages that VR training provides, it is not commonly used as part of core surgical curriculum [6]. Lack of haptic feedback and emotional engagement, technology dependency and costs are known as main disadvantages of VR simulation in surgical education. Several studies reported cybersickness and perceptuomotor after-effects [7].

Table 5. Summary of advantages and disadvantages of VR and simulation in surgical education.

	Advantages	Disadvantages
Educators	Risk-free training	Initial cost and implementation
	Remote learning opportunities	Technology dependency
	Wide range of scenarios
	Objective assessment
Practitioners (trainees, residents)	Realistic practice	Limited haptic feedback
	Procedure familiarization	Lack of emotional engagement
	Immediate feedback	Cybersickness and perceptuomotor after-effects
	Exposure to diverse cases
	Personalized learning
	Remote learning opportunities
Patients	Improved practitioner skills	Technology dependency
	Reduced risk	Lack of emotional engagement

Sources:
[1] Clarke, E. Virtual reality simulation—the future of orthopaedic training? A systematic review and narrative analysis. Adv Simul 6, 2 (2021). https://doi.org/10.1186/s41077-020-00153-x.
[2] Rasic G, Parikh PP, Wang ML, Keric N, Jung HS, Ferguson BD, Altieri MS, Nahmias J. The silver lining of the pandemic in surgical education: virtual surgical education and recommendations for best practices. Global Surg Educ. 2023;2(1):59. doi: 10.1007/s44186-023-00137-1. Epub 2023 May 24. PMID: 38013862; PMCID: PMC10205563.
[3] Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg. 2004 Dec;91(12):1549-58. doi: 10.1002/bjs.4816. PMID: 15547882. ]
[4] Papanikolaou IG, Haidopoulos D, Paschopoulos M, Chatzipapas I, Loutradis D, Vlahos NF. Changing the way we train surgeons in the 21th century: A narrative comparative review focused on box trainers and virtual reality simulators. Eur J Obstet Gynecol Reprod Biol. 2019 Apr;235:13-18. doi: 10.1016/j.ejogrb.2019.01.016. Epub 2019 Jan 22. PMID: 30772529.
[5] Laspro M, Groysman L, Verzella AN, Kimberly LL, Flores RL. The Use of Virtual Reality in Surgical Training: Implications for Education, Patient Safety, and Global Health Equity. Surgeries. 2023; 4(4):635-646. https://doi.org/10.3390/surgeries4040061
[6] Clarke, E. Virtual reality simulation—the future of orthopaedic training? A systematic review and narrative analysis. Adv Simul 6, 2 (2021). https://doi.org/10.1186/s41077-020-00153-x
[7] Baniasadi T, Ayyoubzadeh SM, Mohammadzadeh N. Challenges and Practical Considerations in Applying Virtual Reality in Medical Education and Treatment. Oman Med J. 2020 May 18;35(3):e125. doi: 10.5001/omj.2020.43. PMID: 32489677; PMCID: PMC7232669.