Simulation speeds up adaptation to the 3D exoscope: a randomized controlled trial.

Introduction: Exoscopes are alternatives to operative microscopes in intraoperative visualization. Transitioning from microscope to exoscope demands new skills. Simulators are effective training tools in multiple fields, including surgery, yet no virtual simulators for exoscope training exist. Research question: We developed a virtual exoscope simulator and evaluated whether short-term simulator training improves exoscope control and microsurgical task performance in novices. Material and methods: Forty medical students without prior surgical experience were randomized to a control group or 45 min of simulator training focused on exoscope control. Both groups then performed a standardized microsurgical test task using a real 3D exoscope. The task was a custom-made physical model requiring participants to transit between concealed metal discs (diameter 0.5 cm) at different depths and visual angles while passing a microneedle with 8-0 thread through them, designed to simultaneously assess exoscope camera control and manual microsurgical performance. All participants completed the task three times in a single session. Results: The simulator group demonstrated superior exoscope control by transitioning between the discs faster (median 4min 26s vs. 5min 17s, p = .009) and entering discs faster (median 4min 8s vs. 8min 1s, p = .0006) than the control group. Both groups improved across trials. The standardized effect size was moderate (Cohen's d = 0.56). Groups did not differ significantly in number of exoscope movements or needle drop frequency. Discussion and conclusion: Brief simulator training enhanced adaptation to exoscope controls and manual task performance in novices. Further studies involving neurosurgeons are needed to determine effect on users who possess established microsurgical skills.