The development of a novel virtual reality simulation module for canine laparoscopic ovariectomy

Canine ovariectomy is a commonly performed procedure in veterinary practice and can be done via an open celiotomy or a laparoscopic approach. Laparoscopy requires different psychomotor skills from those involved in open surgery. Many of these basic skills can initially be acquired through simulation-based training. Surgical simulation training benefits both the surgeon and the patient by offering the acquisition of new skills in a less stressful environment while lowering the risk for the patient. Virtual reality (VR) simulation training is well established in human medicine, but no VR modules have previously been available for veterinary procedure training for laparoscopy. This project aimed to develop a VR simulator module for canine laparoscopic ovariectomy on the simulator LapSim® (Surgical Science, Gothenburg, Sweden). The simulator module could offer veterinary surgeons the opportunity to gain the basic technical skills required for canine laparoscopic ovariectomy. Surgeons with experience in laparoscopic ovariectomy acted as content experts, and the development was a stepwise iterative process. The three-port technique was chosen; it included locating and lifting the uterine horn and sealing and transecting tissue to free the ovaries. The organs and tissues the surgeon interacted with during the simulation were the spleen, intestines, pancreas, ovaries, uterine horns, suspensory ligaments, mesometrium and mesovarium. The module included simulating haemorrhage from the spleen, ovarian and uterine vessels. Suggestions for the continued development of the simulation were identified. Examples were an increased haptic feel in some instances of tissue manipulation and the possibility of introducing a variation in the length of the ovarian pedicle. The last step of the simulated procedure included visual guidance for verification of haemostasis. Even though guidance is not part of a real-life operation, identifying anatomical landmarks was considered valuable from an educational perspective. A validity investigation study has been initiated to evaluate the module as an assessment tool.