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A virtual reality simulator for hysteroscopic placement of tubal sterilization micro-inserts: the face and construct validity


Juliënne A. Janse, Sebastiaan Veersema, Frank J. Broekmans, Henk W. R. Schreuder

Gynecological Surgery August 2013, Volume 10, Issue 3, pp 181-188

This study investigated the validity of a virtual reality simulator for hysteroscopic tubal sterilization. Initially performed laparoscopically, the hysteroscopic sterilization method is becoming increasingly popular. An adequate training model could enhance one’s skills prior to the start of performing the procedure on the real patient. This prospective study (Canadian Task force II-2) enrolled 69 residents and gynecologists who were divided into three groups, based on vaginoscopic hysteroscopy and Essure® experience level: novices (N = 17), intermediates (N = 35), and experts (N = 17). Participants completed two cases on a virtual reality simulator (EssureSim™) in which four Essure® placements were performed. A questionnaire was completed to assess face validity, and reality scores were given on a 5-point Likert scale. Construct validity was represented by the ability of six simulator-derived parameters to significantly differentiate between different hysteroscopic experience levels. Reality of the sterilization procedure was scored with a median of 5.00 points on a 5-point Likert scale by all participants with prior sterilization experience. Of these participants, 95.5 % indicated the simulator as a useful preparation for real-time Essure® placement. The expert and intermediate group performed both cases significantly faster than novices (p = .001). The novices had a significantly longer path length in comparison to the other groups (p = .006). Analysis of the remaining parameters did not show a persistent ability to differentiate between experience levels. Satisfactory validity was demonstrated for the EssureSim™ by high reality scores and moderate ability to distinguish between different performance levels.

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