Systematic Review of Virtual Haptics in Surgical Simulation: A Valid Educational Tool?

BACKGROUND: Virtual reality (VR)-based surgical simulation is an expanding and rapidly advancing modality which aims to serve the increasing demand to acquire surgical skills outside the live operating room. Haptic, or force-feedback technology in VR simulation is a rapidly developing field, however the role of haptics in surgical education and its efficacy is unclear. METHODS: A systematic literature search was carried out until September 2018 in MEDLINE, Embase, and Cochrane Library using the following keywords: (VR OR VR OR simulation OR simulator) AND (Haptic feedback OR Haptics OR Force feedback) AND (Surgery). All randomized controlled studies comparing VR training with and without haptics were included. PRISMA guidelines were adhered to RESULTS: Eight randomized controlled trials that com-pare VR training with and without haptics were included and 1 survey study with a total of 215 participants, 116 of which received haptic feedback and 99 were assigned to nonhaptic feedback group. Training tasks included basic proficiency based laparoscopic tasks such as object translocation, cutting, camera navigation, and more com-plex tasks including diathermy, suturing, dissection, knot tying, and operative maneuvers. Six randomized controlled trials demonstrated that haptic enhanced VR simulation is significantly more effective than without haptics for skill training with a reduced learning curve and faster time to proficiency and task completion, par-ticularly in novice learners. Two studies showed no sig-nificant differences in task-assessed parameters between the haptics and nonhaptics cohorts, whereas 1 survey study suggested haptics negatively affected training with decreased realism. CONCLUSION: Haptic feedback has been shown to improve the fidelity, realism and thus the training effect of VR simulators. However, at present haptic simulators are expensive and in a nascent stage and further research as well as cost-benefit analyses of such tools must be considered to determine whether haptics is truly a surgical necessity. (C) 2019 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.