Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training.

Objective: This study aimed to evaluate the educational impact of integrated haptic feedback in an immersive VR bone drilling simulation on the performance of a cohort of junior surgeons. Design: Block randomised, controlled, double-blinded study. Setting: St Georges University Hospital, London, United Kingdom. Participants: and methods: 31 trainee doctors (postgraduate years 1-3) with limited orthopaedic experience were recruited to participate in this randomised controlled study through e-mail and poster advertising. They were allocated to haptic or non-haptic group through block randomisation prior to entering the study environment. All participants provided verbal and written consent to participate in this study. All participants were blinded to the nature of the study as well as its intervention arms. All participants completed an immersive virtual reality training module with either haptic feedback or no haptic feedback in which they had to drill 3 bicortical holes in a VR tibia bone model in preparation for screw insertion followed by an ex vivo equivalent task on a tibial sawbone model once again drilling 3 holes through both cortices of the tibia. Outcome measures were plunge gap distance, drilling time and objective structures assessment of technical skills (OSAT) as well as qualitative questionnaire outcomes. Results: Haptic feedback in the VR training module showed significantly less plunge gap distance compared to the non-haptic group (7.6 mm ± 4.3 vs 13.6 mm ± 7.4 (p = 0.012)). The haptic group also had longer drill times (17.5 s ± 4.0 vs 13.8 s ± 4.2 (p = 0.027)), higher combined OSAT cores (14 (10,17) vs 8.5 (7.75, 12), p = 0.0006) and greater number of safe drills of <5 mm plunge gap in at least 2 out of 3 attempts (6 (40) vs 0 (0), p = 0.021. Conclusions: This study demonstrates better performance for an orthopaedic surgical task when using a VR-based simulation model incorporating haptic feedback, compared to one without haptic feedback supporting the pursuit and implementation of haptics in surgical training simulation models to enhance their educational value.