Three-dimensional microscope skill acquisition: A randomised controlled study comparing two-dimensional laboratory microscope training, video gaming and virtual reality gaming.

Introduction: Fine microsurgical motor skill acquisition can be challenging. With increasing technological innovation, the methods of microsurgical skills acquisition may change. Studies show that laboratory-based microsurgical training programmes on a 2D microscope significantly improves the microsurgical skill acquisition of novices. However, it remains to be seen if these skills are transferable to a 3D microscope or if gaming agility is more important? We present a randomised control trial of three interventions, namely laboratory tabletop microscope training (LM), high-fidelity video gaming (Sony PlayStation 4 console; VG) and high-fidelity virtual reality gaming (Sony PlayStation VR console; VR) versus a control group.

Methods: Forty novice medical students were block randomised to four groups: control (no intervention) n = 10, LM n = 10, VG n = 10 and VR n = 10. Participants performed chicken femoral artery anastomosis using the Aesculap Aeos® 3D microscope platform at the baseline and again after the intervention. Performance was evaluated using a modified structured assessment of microsurgery skills (mSAMS) score, time taken to complete anastomosis and time taken for suture placement by two blinded independent assessors.

Result: No statistically significant difference was noted between the groups at the baseline. There was a statistically significant improvement in the LM arm between the baseline and post-training for mSAMS score and time for suture placement. In the VG, VR and control groups no statistically significant difference was observed.

Conclusion: Our study demonstrates that during early microsurgical training, an intense laboratory-based microsurgical training programme significantly improves a novice's anastomotic performance on a 2D microscope, and these skills are transferable when a 3D anastomosis is carried out. However, focused gaming had no significant effect, and the results were akin to that of the non-intervention group.