Virtual reality laparoscopic simulation for operating theatre efficiency: an outcome logic model program evaluation

Introduction
This article describes introduction of a comprehensive laparoscopic simulation education program to enhance operative efficiency in gynaecological procedures. We describe our approach to educational design, clinical integration and evaluation using an outcome logic model.

Methods
The study was conducted at Gold Coast Hospital Health Service (GCHHS) following the purchase of a laparoscopic virtual reality (VR) laparoscopic simulator (LAPSIM® VR), and development of a training program for obstetrics and gynaecology (O&G) trainees. In 2021, a surgical laparoscopic credentialling simulation program was introduced, requiring trainees to achieve a ‘pass’ on the LAPSIM® VR simulator prior to operating on patients. The evaluation approach used an outcome logic model to document program objectives and outcomes. Data analysis involved multivariate linear regression to ascertain the impact of the laparoscopic simulation program on procedure length in the operating theatre.

Results
Inputs included faculty and trainee time, space, LAPSIM® VR equipment and take-home laparoscopic box trainers. Activities involved online instructional modules, training and surgical learning sessions. Outputs included trainee utilization of LAPSIM® VR and credentialling. Outcomes included surveys, retrospective reviews of patient laparoscopic salpingectomies and primary surgeon operator rates. LAPSIM® VR credentialling was performed by 81% of the GCHHS gynaecology registrar cohort in 2021. Trainees completed 234 VR salpingectomies. Introduction of the LAPSIM® VR program was associated with a significant reduction in mean operative time for all ectopic pregnancies in all primary surgeon groups. For uncomplicated ectopic procedures, there was a reduction in operative time of 14 minutes between 2020 and 2021 (p = 0.001, 95% CI: 9–19 minutes) after adjusting for instrument and surgeon level. Credentialled trainees were no more likely to be a primary operator than those who were not credentialled. Survey results revealed that trainees felt the LAPSIM® VR program improved their technical skills, but that other factors influenced their likelihood of being primary operator.

Discussion
Introduction of a laparoscopic simulation VR credentialling program resulted in a significant reduction in operative time for laparoscopic salpingectomies in our institution. Educational programs should aspire to translational, patient-focused outcomes in their design and delivery.