Influence of distraction factors on performance in laparoscopic Surgery in immersive Virtual Reality – a study protocol of a cross-over trial in medical students and residents - DisLapVR

Background: Working in an operating room (OR) is physically and mentally challenging: the operation itself demands the surgeon’s full attention, while owing to time and cost efficiency constraints daily planning and emergency care keep interfering on different levels. Thus, multitasking becomes an integral surgical competence. This study aims to examine the effect of disruptions during surgery in highly immersive virtual reality (IVR) operation environment combined with a VR laparoscopy simulator. Methods: An IVR environment was created using a high resolution, stereoscopic 360° video of the OR. Different distractions were identified, classified as auditory, visual or audio-visual and recorded accordingly. The surrounding was combined with a VR laparoscopic simulator. Participants - medical students and surgical residents - receive proficiency-based training in basic laparoscopic skills and are blinded to the aim of the experiment. Following a cross-over design, each participant receives a unique order of virtual distraction factors while performing tasks on the laparoscopic simulator. During the experiment, subjective passing of time, stress, heart rate and visually induced motion sickness are recorded. After the experiment, validated questionnaires for usability, immersion and stress are completed, as well as subjective evaluation of the distractions. Performance in the laparoscopic tasks in relation to the distractions will be evaluated. Subgroup analyses in regard of age, gender and expertise (medical students vs. surgical residents) are planned. Discussion: We present a protocol for a study aiming to identify the impact of different disruptions in the OR during laparoscopic training in immersive VR. Hence, it may lead to an improved awareness of distractions and facilitate accommodations towards an improved work environment. Prior research leads to the hypothesis that the performance of a more experienced surgeon is less impacted by distractions, than the performance of inexperienced surgeons and medical students. Furthermore, we investigate which type of distraction has the largest impact on performance. With this knowledge, specific multitasking training can be devised, which may be particularly useful in medical education, for which VR might play a leading role. Trial registration This trial has been prospectively registered in the German Clinical Trials register with the registration number DRKS 00030033, registration confirmed 18th of August 2022, https://www.drks.de/drks_web/