Needs analysis for the development of a virtual reality laparoscopic hiatal hernia repair simulator

Laparoscopic hiatal hernia (HH) surgery is a complex procedure associated with high recurrence. The objective of this project was to develop a virtual reality (VR) simulator for HH surgery to ultimately enhance surgeon performance.

A 48-item survey was created to assess demographics, prior experience, procedure specific training, preferences regarding procedural details, and desired simulator features. A REDCap survey was distributed to 250 expert U.S. foregut surgeons. Their importance ratings of procedural steps and simulation preferences were analyzed using a non-parametric Kruskal–Wallis test.

There were 44 complete survey respondents (20% response rate). Participants’ clinical experience was > 15 years (48%), 5–15 years (29.5%), and < 5 years (23%). Intraoperative teaching and dedicated fellowship were the two primary training methods. The case numbers for proficiency were reported as 11–20 (18%), 21–30 (27%), 31–40 (23%), and > 40 (30%). Crural closure and fundoplication were performed with intracorporeal knot tying. Fundoplication preferences included Nissen (41%), Toupet (48%), and Dor (2%). Experts agreed on the simulation feature preferences as well as the importance of key steps (p > 0.05), except for use of endoscopy (p = 0.032).

The results from this survey will form the basis for constructing a VR simulator model for laparoscopic HH surgery based on current clinical practice. Expert consensus was achieved for importance ratings in fundoplication steps and simulation features, which will facilitate operative performance assessment.