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Face and construct validation of a next generation virtual reality (Gen2-VR©) surgical simulator



Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR©) system to train surgeons in these environments. This study was to establish face and construct validity of our system.

Methods and procedures

The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: Case I: traditional VR; Case II: Gen2-VR© with no distractions and Case III: Gen2-VR© with distractions and interruptions. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 s and tools malfunctioned for 15 s at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study.


Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.0001), (Case I, Case III, p < 0.0001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean 4.18) and tool malfunction (median 4.56) significantly hindered their performance.


The results showed that Gen2-VR© simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.

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We gratefully acknowledge the support of this work through NIH/NIBIB 2R01EB005807.


Dr. Daniel B. Jones is the chair of the SAGES FUSE committee and consultant to Allurion and Intuitive Surgical. Dr. Schwaitzberg has served on advisory panels and has received an honorarium from Stryker and Olympus. He has served on advisory panels for Neatstitch and Surgicquest, Arch Therapeutics Acuity Bio and Human Extensions. He has also received a Grant from Ethicon. Drs. Sankaranarayanan and De serve are members in the SAGES FUSE committee. Mr. Li, Manser, Drs. Caroline, G. L. Cao and Stephanie B. Jones have no conflicts of interest or financial ties to disclose.

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Correspondence to Suvranu De.

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Sankaranarayanan, G., Li, B., Manser, K. et al. Face and construct validation of a next generation virtual reality (Gen2-VR©) surgical simulator. Surg Endosc 30, 979–985 (2016). https://doi.org/10.1007/s00464-015-4278-7

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  • Immersive virtual reality
  • Surgery simulator
  • Head-mounted display
  • Cognitive simulator
  • Face and construct validation
  • Gen2-VR©