{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T15:02:48Z","timestamp":1787324568717,"version":"build-2736575974"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Prenatal Diagnosis"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and validate a novel virtual reality (VR) simulation system for training fetoscopic laser placental photocoagulation in twin\u2010to\u2010twin transfusion syndrome (TTTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A VR\u2010based simulator incorporating Meta Quest headsets and custom\u2010designed hardware was developed. The system features realistic anatomical modeling, integrated performance metrics, and progressive training modules. Validation involved 31 participants (11 experienced fetal therapy specialists, 10 fetal therapy fellows, and 10 other maternal\u2010fetal medicine specialists) who evaluated the simulator across five domains using a standardized questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The simulator demonstrated excellent internal consistency (Cronbach's <jats:italic>\u03b1<\/jats:italic>\u00a0=\u00a00.92) with strong positive validation across all measured aspects. Training effectiveness received the highest endorsement (87%, 95% CI: 83%\u201391%), followed by user engagement (85%, 95% CI: 81%\u201389%). Experienced specialists rated environmental realism significantly higher (4.8\u00a0\u00b1\u00a00.3, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.002), while fellows provided the strongest endorsement for training effectiveness (4.8\u00a0\u00b1\u00a00.3, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.004).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This VR simulator represents a significant advancement in TTTS surgical education, offering comprehensive training capabilities without requiring practice on actual patients. Initial testing demonstrates feasibility for both local and remote teaching applications, with potential advantages in cost, portability, and educational capabilities compared to traditional physical simulators.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6807","type":"journal-article","created":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T21:45:51Z","timestamp":1746135951000},"page":"772-777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Virtual Reality Simulation in Teaching Fetoscopic Laser Placental Photocoagulation in Twin\u2010To\u2010Twin Transfusion Syndrome"],"prefix":"10.1002","volume":"45","author":[{"given":"Catherine","family":"Windrim","sequence":"first","affiliation":[{"name":"Ontario Fetal Centre Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Charleson","sequence":"additional","affiliation":[{"name":"Ontario Tech University  Oshawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Rojas","family":"Gualdron","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Quevedo","sequence":"additional","affiliation":[{"name":"Ontario Tech University  Oshawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Gotha","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3034-6905","authenticated-orcid":false,"given":"Tim","family":"Van Mieghem","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"Ryan","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3009-0353","authenticated-orcid":false,"given":"Rory","family":"Windrim","sequence":"additional","affiliation":[{"name":"Ontario Fetal Centre Department of Obstetrics and Gynaecology Mount Sinai Hospital  Toronto Canada"},{"name":"Department of Obstetrics and Gynaecology University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000313300"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14670"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12402"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.10.910"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14916"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2012.10.626"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.4284"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2020.05.004"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2022.03.019"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469\u20100705.2002.00701.x"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.6490"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5926"},{"key":"e_1_2_13_14_1","volume-title":"Windows Mixed Reality Development Documentation","author":"Microsoft Docs","year":"2023"},{"key":"e_1_2_13_15_1","unstructured":"Meta Meta Quest Developer Documentation (2024): Published online."},{"key":"e_1_2_13_16_1","unstructured":"Unity Technologies Universal Render Pipeline Overview and Architecture (2023): Published online."},{"key":"e_1_2_13_17_1","unstructured":"Unity Technologies XR Interaction Toolkit Documentation Version 2.3 (2023): Published online."},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD006575.pub2"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010017\u20105500\u20106"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/13645706.2016.1275016"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.31217"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.06.045"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.14761"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12492"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.08.004"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.07.064"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.11622\/smedj.2020137"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1017\/thg.2016.24"}],"container-title":["Prenatal Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pd.6807","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:17:40Z","timestamp":1759882660000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pd.6807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/pd.6807"],"URL":"https:\/\/doi.org\/10.1002\/pd.6807","archive":["Portico"],"relation":{},"ISSN":["0197-3851","1097-0223"],"issn-type":[{"value":"0197-3851","type":"print"},{"value":"1097-0223","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"assertion":[{"value":"2025-01-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}