{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T23:17:05Z","timestamp":1785367025689,"version":"3.55.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006470","name":"Aristotle University of Thessaloniki","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006470","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Updates Surg"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Up to this date, there have been no reports on immersive virtual reality (IVR) training in thyroid surgery. The purpose of this blinded, randomized controlled trial was to determine the validity and impact of VR training in residents\u2019 education. Nineteen general surgery residents participated in the trial comparing IVR with traditional learning, utilizing a technical textbook as a control. A stratified randomization was used to secure balance in the distribution of residents according to their experience. The examined task pertained to the surgical steps from neck incision up to the placement of the continuous\u00a0intraoperative neuromonitoring electrode and was evaluated by a blinded Fellow of the European Board of Surgery (FEBS) certified endocrine surgeon. Training superiority was assessed by the outcome measures of Objective Structured Assessment of Technical Skills (OSATS) score, need for the main surgeon to intervene, verbal answers, and time to task completion. Participants completed questionnaires regarding face validity and perceived benefits of the educational process. Immersive VR group completed the task significantly faster (p\u2009=\u20090.012), at a mean time of 27.25\u2009\u00b1\u20093.8 vs 35.25\u2009\u00b1\u20096.5\u00a0min in the control group, and was superior in OSATS Overall score (p\u2009=\u20090.035), knowledge of instruments (p\u2009=\u20090.015) and flow of operation (p\u2009=\u20090.021) scores. In the dedicated questionnaire, the participants of the IVR group stated greater overall satisfaction of the educational process (p\u2009=\u20090.002), ease of use (p\u2009=\u20090.015), enjoyment (p\u2009&lt;\u20090.001), repetitivity (0.001), and perceived improvement in surgical technique (0.021). The IVR group dedicated more time in training 39\u2009\u00b1\u20098.9 vs 27.5\u2009\u00b1\u20097.2\u00a0min (p\u2009=\u20090.014), and performed more repetitions of the educative module,\u00a03.5 (2\u20135) vs 2 (1\u20133) (p\u2009=\u20090.003) than the control group. IVR training demonstrated improved outcomes in several translational technical skills acquisition over traditional learning, while yielding improved satisfaction and repetitivity for participants.\n                    <jats:italic>Clinical trials registration number No<\/jats:italic>\n                    : NCT06917755.\n                  <\/jats:p>","DOI":"10.1007\/s13304-025-02387-8","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T11:43:55Z","timestamp":1756467835000},"page":"2535-2543","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The impact of immersive virtual reality training in thyroid surgery: a prospective randomized controlled trial"],"prefix":"10.1007","volume":"77","clinical-trial-number":[{"clinical-trial-number":"nct06917755","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7700-1872","authenticated-orcid":false,"given":"Anestis","family":"Basios","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8316-4726","authenticated-orcid":false,"given":"Nikolaos","family":"Voloudakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanos","family":"Atmatzidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Velikoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Bellou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1663-4839","authenticated-orcid":false,"given":"Kyriakos","family":"Vamvakidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basileios","family":"Papaziogas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3192-5666","authenticated-orcid":false,"given":"Ioannis","family":"Koutelidakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"2387_CR1","doi-asserted-by":"publisher","DOI":"10.2196\/37599","author":"P Sun","year":"2023","unstructured":"Sun P, Zhao Y, Men J et al (2023) Application of virtual and augmented reality technology in hip surgery: systematic review. J Med Internet Res. https:\/\/doi.org\/10.2196\/37599","journal-title":"J Med Internet Res"},{"key":"2387_CR2","unstructured":"Milgram P, Drascic D, Grodski JJ, et al. (1995) Merging real and virtual worlds. In: Proceedings of IMAGINA\u201995"},{"key":"2387_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12891-020-3110-2","volume":"21","author":"L Jud","year":"2020","unstructured":"Jud L, Fotouhi J, Andronic O et al (2020) Applicability of augmented reality in orthopedic surgery - a systematic review. BMC Musculoskelet Disord 21:1\u201313. https:\/\/doi.org\/10.1186\/S12891-020-3110-2","journal-title":"BMC Musculoskelet Disord"},{"key":"2387_CR4","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1302\/0301-620X.100B5.BJJ-2017-1439","volume":"100-B","author":"JD Bartlett","year":"2018","unstructured":"Bartlett JD, Lawrence JE, Stewart ME et al (2018) Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? The Bone & Joint Journal 100-B:559\u2013565. https:\/\/doi.org\/10.1302\/0301-620X.100B5.BJJ-2017-1439","journal-title":"The Bone & Joint Journal"},{"key":"2387_CR5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000038813","volume":"103","author":"C Elendu","year":"2024","unstructured":"Elendu C, Amaechi DC, Okatta AU et al (2024) The impact of simulation-based training in medical education: a review. Medicine (Baltimore) 103:e38813. https:\/\/doi.org\/10.1097\/MD.0000000000038813","journal-title":"Medicine (Baltimore)"},{"key":"2387_CR6","doi-asserted-by":"publisher","DOI":"10.1001\/JAMANETWORKOPEN.2020.31217","author":"R Lohre","year":"2020","unstructured":"Lohre R, Bois AJ, Pollock JW et al (2020) Effectiveness of immersive virtual reality on orthopedic surgical skills and knowledge acquisition among senior surgical residents: a randomized clinical trial. JAMA Netw Open. https:\/\/doi.org\/10.1001\/JAMANETWORKOPEN.2020.31217","journal-title":"JAMA Netw Open"},{"key":"2387_CR7","doi-asserted-by":"publisher","DOI":"10.2196\/35000","author":"F Pallavicini","year":"2022","unstructured":"Pallavicini F, Pepe A, Clerici M, Mantovani F (2022) Virtual reality applications in medicine during the COVID-19 pandemic: systematic review. JMIR Serious Games. https:\/\/doi.org\/10.2196\/35000","journal-title":"JMIR Serious Games"},{"key":"2387_CR8","doi-asserted-by":"publisher","DOI":"10.1093\/BJSOPEN\/ZRAA066","author":"MW Schmidt","year":"2021","unstructured":"Schmidt MW, K\u00f6ppinger KF, Fan C et al (2021) Virtual reality simulation in robot-assisted surgery: meta-analysis of skill transfer and predictability of skill. BJS Open. https:\/\/doi.org\/10.1093\/BJSOPEN\/ZRAA066","journal-title":"BJS Open"},{"key":"2387_CR9","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1308\/RCSANN.2020.0178","volume":"102","author":"M Portelli","year":"2020","unstructured":"Portelli M, Bianco SF, Bezzina T, Abela JE (2020) Virtual reality training compared with apprenticeship training in laparoscopic surgery: a meta-analysis. Ann R Coll Surg Engl 102:672\u2013684. https:\/\/doi.org\/10.1308\/RCSANN.2020.0178","journal-title":"Ann R Coll Surg Engl"},{"key":"2387_CR10","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/J.JSS.2021.06.045","volume":"268","author":"RQ Mao","year":"2021","unstructured":"Mao RQ, Lan L, Kay J et al (2021) Immersive virtual reality for surgical training: a systematic review. J Surg Res 268:40\u201358. https:\/\/doi.org\/10.1016\/J.JSS.2021.06.045","journal-title":"J Surg Res"},{"key":"2387_CR11","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1046\/J.1365-2168.1997.02502.X","volume":"84","author":"JA Martin","year":"1997","unstructured":"Martin JA, Regehr G, Reznick R et al (1997) Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273\u2013278. https:\/\/doi.org\/10.1046\/J.1365-2168.1997.02502.X","journal-title":"Br J Surg"},{"key":"2387_CR12","doi-asserted-by":"publisher","DOI":"10.1093\/BJS\/ZNAE199","author":"M Raffaelli","year":"2024","unstructured":"Raffaelli M, Voloudakis N, Barczynski M et al (2024) European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg. https:\/\/doi.org\/10.1093\/BJS\/ZNAE199","journal-title":"Br J Surg"},{"key":"2387_CR13","doi-asserted-by":"crossref","unstructured":"Shifrin Alexander (2022) Atlas of thyroid surgery. 239","DOI":"10.1007\/978-3-030-93673-0"},{"key":"2387_CR14","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1016\/J.JSURG.2016.04.023","volume":"73","author":"JA Bernard","year":"2016","unstructured":"Bernard JA, Dattilo JR, Srikumaran U et al (2016) Reliability and validity of 3 methods of assessing orthopedic resident skill in shoulder surgery. J Surg Educ 73:1020\u20131025. https:\/\/doi.org\/10.1016\/J.JSURG.2016.04.023","journal-title":"J Surg Educ"},{"key":"2387_CR15","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1016\/J.SURG.2009.10.068","volume":"147","author":"SS Van Nortwick","year":"2010","unstructured":"Van Nortwick SS, Lendvay TS, Jensen AR et al (2010) Methodologies for establishing validity in surgical simulation studies. Surgery 147:622\u2013630. https:\/\/doi.org\/10.1016\/J.SURG.2009.10.068","journal-title":"Surgery"},{"key":"2387_CR16","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1017\/CTS.2017.310","volume":"1","author":"C Tu","year":"2017","unstructured":"Tu C, Benn EKT (2017) RRapp, a robust randomization app, for clinical and translational research. J Clin Transl Sci 1:323\u2013327. https:\/\/doi.org\/10.1017\/CTS.2017.310","journal-title":"J Clin Transl Sci"},{"key":"2387_CR17","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1007\/BF00594110","volume":"7","author":"RM Satava","year":"1993","unstructured":"Satava RM (1993) Virtual reality surgical simulator. The first steps. Surg Endosc 7:203\u2013205. https:\/\/doi.org\/10.1007\/BF00594110","journal-title":"Surg Endosc"},{"key":"2387_CR18","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/179569","author":"F Luc\u00e0","year":"2013","unstructured":"Luc\u00e0 F, Van Garsse L, Rao CM et al (2013) Minimally invasive mitral valve surgery: a systematic review. Minim Invasive Surg. https:\/\/doi.org\/10.1155\/2013\/179569","journal-title":"Minim Invasive Surg"},{"key":"2387_CR19","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1007\/S00464-005-0384-2","volume":"19","author":"FJ Carter","year":"2005","unstructured":"Carter FJ, Schijven MP, Aggarwal R et al (2005) Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19:1523\u20131532. https:\/\/doi.org\/10.1007\/S00464-005-0384-2","journal-title":"Surg Endosc"},{"key":"2387_CR20","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1177\/1553350615583559","volume":"22","author":"J Olasky","year":"2015","unstructured":"Olasky J, Sankaranarayanan G, Seymour NE et al (2015) Identifying opportunities for virtual reality simulation in surgical education: a review of the proceedings from the Innovation, Design, and Emerging Alliances in Surgery (IDEAS) Conference: VR surgery. Surg Innov 22:514\u2013521. https:\/\/doi.org\/10.1177\/1553350615583559","journal-title":"Surg Innov"},{"key":"2387_CR21","doi-asserted-by":"publisher","DOI":"10.5281\/ZENODO.14838243","author":"G Enani","year":"2024","unstructured":"Enani G, Muller C (2024) Strategies for optimizing trainee engagement and motivation in surgical simulation laboratory. Int J Surg Educ. https:\/\/doi.org\/10.5281\/ZENODO.14838243"},{"key":"2387_CR22","doi-asserted-by":"publisher","DOI":"10.1136\/BMJOPEN-2023-072851","volume":"13","author":"C Clement","year":"2023","unstructured":"Clement C, Coulman K, Heywood N et al (2023) How surgical trainee research collaboratives achieve success: a mixed methods study to develop trainee engagement strategies. BMJ Open 13:e072851. https:\/\/doi.org\/10.1136\/BMJOPEN-2023-072851","journal-title":"BMJ Open"},{"key":"2387_CR23","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1056\/NEJMOA1515724","volume":"374","author":"KY Bilimoria","year":"2016","unstructured":"Bilimoria KY, Chung JW, Hedges LV et al (2016) National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med 374:713\u2013727. https:\/\/doi.org\/10.1056\/NEJMOA1515724","journal-title":"N Engl J Med"},{"key":"2387_CR24","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1016\/J.AMJSURG.2021.10.005","volume":"223","author":"CH Mullins","year":"2022","unstructured":"Mullins CH, Lindeman B (2022) Ending the burnout gender gap in surgery. Am J Surg 223:608. https:\/\/doi.org\/10.1016\/J.AMJSURG.2021.10.005","journal-title":"Am J Surg"},{"key":"2387_CR25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-025-87093-6","volume":"15","author":"F Khanipoor","year":"2025","unstructured":"Khanipoor F, Fereidouni Z, Far SN et al (2025) Understanding Burnout among Surgical residents: a mixed method study. Sci Rep 15:1\u201313. https:\/\/doi.org\/10.1038\/s41598-025-87093-6","journal-title":"Sci Rep"},{"key":"2387_CR26","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1016\/J.JSURG.2023.06.023","volume":"80","author":"L Shaban","year":"2023","unstructured":"Shaban L, Mkandawire P, O\u2019Flynn E et al (2023) Quality metrics and indicators for surgical training: a scoping review. J Surg Educ 80:1302\u20131310. https:\/\/doi.org\/10.1016\/J.JSURG.2023.06.023","journal-title":"J Surg Educ"},{"key":"2387_CR27","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/S13304-020-00871-X","volume":"73","author":"G Donatini","year":"2021","unstructured":"Donatini G, Bakkar S, Leclere FM et al (2021) Simlife model: introducing a new teaching device in endocrine surgery simulation. Update Surg 73:289\u2013295. https:\/\/doi.org\/10.1007\/S13304-020-00871-X","journal-title":"Update Surg"},{"key":"2387_CR28","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1002\/OHN.630","volume":"170","author":"A Rulli\u00e8re","year":"2024","unstructured":"Rulli\u00e8re A, Danion J, Fieux M et al (2024) SimLife\u00ae: a new dynamic model for head and neck surgical oncology simulation. Otolaryngol Head Neck Surg 170:972\u2013976. https:\/\/doi.org\/10.1002\/OHN.630","journal-title":"Otolaryngol Head Neck Surg"},{"key":"2387_CR29","doi-asserted-by":"publisher","first-page":"181","DOI":"10.7861\/FHJ.2019-0036","volume":"6","author":"J Pottle","year":"2019","unstructured":"Pottle J (2019) Virtual reality and the transformation of medical education. Future Healthc J 6:181. https:\/\/doi.org\/10.7861\/FHJ.2019-0036","journal-title":"Future Healthc J"},{"key":"2387_CR30","doi-asserted-by":"publisher","DOI":"10.1001\/JAMASURG.2017.6233","author":"CP Childers","year":"2018","unstructured":"Childers CP, Maggard-Gibbons M (2018) Understanding costs of care in the operating room. JAMA Surg. https:\/\/doi.org\/10.1001\/JAMASURG.2017.6233","journal-title":"JAMA Surg"},{"key":"2387_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/J.JSURG.2024.103304","author":"T Tricard","year":"2025","unstructured":"Tricard T, Pan JH, Song QX et al (2025) Validation of the objective structured assessment of technical skill (OSATS) in China. J Surg Educ. https:\/\/doi.org\/10.1016\/J.JSURG.2024.103304","journal-title":"J Surg Educ"},{"key":"2387_CR32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/J.EJOGRB.2014.04.032","volume":"178","author":"F Alici","year":"2014","unstructured":"Alici F, Buerkle B, Tempfer CB (2014) Objective structured assessment of technical skills (OSATS) evaluation of hysteroscopy training: a prospective study. Eur J Obstet Gynecol Reprod Biol 178:1\u20135. https:\/\/doi.org\/10.1016\/J.EJOGRB.2014.04.032","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2387_CR33","doi-asserted-by":"publisher","first-page":"e99","DOI":"10.1016\/J.JCJO.2022.08.014","volume":"58","author":"R Curtis","year":"2023","unstructured":"Curtis R, Pucchio A, Hopman W et al (2023) Validation of a microsurgical video-based scoring system for evaluating corneal suturing performance. Can J Ophthalmol 58:e99\u2013e100. https:\/\/doi.org\/10.1016\/J.JCJO.2022.08.014","journal-title":"Can J Ophthalmol"},{"key":"2387_CR34","doi-asserted-by":"publisher","first-page":"2572","DOI":"10.1016\/J.ARTHRO.2016.05.037","volume":"32","author":"T Dwyer","year":"2016","unstructured":"Dwyer T, Slade Shantz J, Kulasegaram KM et al (2016) Use of an objective structured assessment of technical skill after a sports medicine rotation. Arthroscopy 32:2572-2581.e3. https:\/\/doi.org\/10.1016\/J.ARTHRO.2016.05.037","journal-title":"Arthroscopy"}],"container-title":["Updates in Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02387-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s13304-025-02387-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s13304-025-02387-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T07:50:01Z","timestamp":1763538601000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s13304-025-02387-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":34,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["2387"],"URL":"https:\/\/doi.org\/10.1007\/s13304-025-02387-8","relation":{"references":[{"id-type":"doi","id":"10.5281\/ZENODO.14838243","asserted-by":"subject"}]},"ISSN":["2038-131X","2038-3312"],"issn-type":[{"value":"2038-131X","type":"print"},{"value":"2038-3312","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"assertion":[{"value":"17 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Authors have no conflicts of interest or financial ties to disclose regarding this work. The authors have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Scientific Board of G.Gennimatas General Hospital of Thessaloniki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent by participants and patients were obtained according to study protocol and could be provided upon reasonable request. Also, the authors affirm that human research participants provided informed consent for publication of the images in Figs.\u00a0\n                      \n                      ,\n                      \n                      and\n                      \n                      .","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}