{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T12:01:42Z","timestamp":1772452902562,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Digital"],"abstract":"<jats:p>Traditional methods to learn soft-tissue surgical procedures rely on cadaver labs or patient-based learning, which are costly and geographically limited, and raise ethical questions. Virtual reality (VR) with haptic feedback offers a scalable alternative, but most current platforms emphasize bone-based rather than soft-tissue procedures learned by feel. We developed a VR+haptic simulation for preoperative training of retropubic midurethral sling (MUS) surgery. This study examines the usability of this platform with thirteen expert urogynecologic surgeons and subsequently makes improvements (e.g., in haptics) to evaluate the platform with twelve trainees based on the NASA Task Load Index for workload and a UTAUT-informed usability survey. Objective performance scores were recorded as participants completed up to four levels of increasing realism and difficulty, starting with a transparent body and a reference surgical trajectory. Trainees reported high usability, immersion, and engagement. Experts rated the platform as valuable for sling training and skill assessment. NASA-TLX results indicated low physical and temporal demand, low mental demand and frustration, and moderate effort. These findings suggest that SurgicalEd VR is acceptable and has appropriate workload characteristics for surgical education. Future studies could examine how using VR+ haptic training improves intraoperative performance.<\/jats:p>","DOI":"10.3390\/digital6010018","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Leveraging Virtual Reality and Haptics to Teach Surgical Skills: A Usability Study on Retropubic Midurethral Slings"],"prefix":"10.3390","volume":"6","author":[{"given":"Lauren","family":"Siff","sequence":"first","affiliation":[{"name":"Surgery, Central Virginia VA Health Care System, Richmond, VA 23249, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7197-1654","authenticated-orcid":false,"given":"Ginger S.","family":"Watson","sequence":"additional","affiliation":[{"name":"Virginia Modeling, Analysis, and Simulation Center (VMASC), Old Dominion University, Suffolk, VA 23435, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8622-0597","authenticated-orcid":false,"given":"Jerome","family":"Dixon","sequence":"additional","affiliation":[{"name":"Integrative Life Sciences, Virginia Commonwealth University, Richmond, VA 23220, USA"},{"name":"School of Data Science, University of Virginia, Charlottesville, VA 22903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2000-2551","authenticated-orcid":false,"given":"Moshe","family":"Feldman","sequence":"additional","affiliation":[{"name":"School of Medicine, Virginia Commonwealth University, Richmond, VA 23220, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franklin","family":"Bost","sequence":"additional","affiliation":[{"name":"Institute of Engineering and Medicine, Virginia Commonwealth University, Richmond, VA 23220, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6816-355X","authenticated-orcid":false,"given":"Philippe J.","family":"Giabbanelli","sequence":"additional","affiliation":[{"name":"Virginia Modeling, Analysis, and Simulation Center (VMASC), Old Dominion University, Suffolk, VA 23435, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","first-page":"403","article-title":"Coordinated multiple cadaver use for minimally invasive surgical training","volume":"11","author":"Blaschko","year":"2007","journal-title":"JSLS J. Soc. Laparoendosc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.hcl.2024.12.011","article-title":"The Role of Cadaver-Based Laboratories Versus 3 Dimensional Virtual Training in Surgical Teaching","volume":"41","author":"Burnier","year":"2025","journal-title":"Hand Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1046\/j.1365-2923.2003.01440.x","article-title":"Simulation in surgical training: Educational issues and practical implications","volume":"37","author":"Kneebone","year":"2003","journal-title":"Med. Educ."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shahrezaei, A., Sohani, M., Taherkhani, S., and Zarghami, S.Y. (2024). The impact of surgical simulation and training technologies on general surgery education. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-06299-w"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1002\/lio2.277","article-title":"A review of simulation applications in temporal bone surgery","volume":"4","author":"Kashikar","year":"2019","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e37599","DOI":"10.2196\/37599","article-title":"Application of virtual and augmented reality technology in hip surgery: Systematic review","volume":"25","author":"Sun","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bjelovucic, R., Wolff, J., N\u00f8rholt, S.E., Pauwels, R., and Taneja, P. (2025). Effectiveness of Mixed Reality in Oral Surgery Training: A Systematic Review. Sensors, 25.","DOI":"10.3390\/s25133945"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00268-007-9150-z","article-title":"Surgical simulator design and development","volume":"32","author":"Dankelman","year":"2008","journal-title":"World J. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1777","DOI":"10.1002\/nau.25257","article-title":"Surgical education in urogynecology from low fidelity to virtual reality: Systematic review","volume":"42","author":"Patel","year":"2023","journal-title":"Neurourol. Urodynamics"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s41077-020-00153-x","article-title":"Virtual reality simulation\u2014the future of orthopaedic training? A systematic review and narrative analysis","volume":"6","author":"Clarke","year":"2021","journal-title":"Adv. Simul."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.3332\/ecancer.2023.1525","article-title":"Virtual reality and surgical oncology","volume":"17","author":"Ng","year":"2023","journal-title":"Ecancermedicalscience"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Siff, L., Dixon, J., Bost, F.L., and Feldman, M. (2026). A virtual reality surgical training system for haptic based \u2018blind\u2019 surgical procedures. J. Minim. Invasive Gynecol., in press.","DOI":"10.1016\/j.jmig.2026.01.064"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/SPV.0000000000001791","article-title":"What Makes an Expert Surgeon? Novel Metrics for Evaluating Skills in Simulation","volume":"32","author":"Siff","year":"2026","journal-title":"Urogynecology"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Pakkasj\u00e4rvi, N., Anttila, H., and Pyh\u00e4lt\u00f6, K. (2024). What are the learning objectives in surgical training\u2013a systematic literature review of the surgical competence framework. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-05068-z"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1053\/j.semvascsurg.2006.08.010","article-title":"Core training in surgery: What does it need to include?","volume":"Volume 19","author":"Potts","year":"2006","journal-title":"Seminars in Vascular Surgery"},{"key":"ref_16","first-page":"90","article-title":"The complexity of the retropubic midurethral sling: A cognitive task analysis","volume":"27","author":"Ackenbom","year":"2021","journal-title":"Urogynecology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.hpb.2017.01.016","article-title":"Training in minimally invasive pancreatic resections: A paradigm shift away from \u201csee one, do one, teach one\u201d","volume":"19","author":"Hogg","year":"2017","journal-title":"Hpb"},{"key":"ref_18","unstructured":"(2026, February 02). Limbs & Things. Available online: https:\/\/limbsandthings.com\/."},{"key":"ref_19","unstructured":"(2026, February 02). The Miya Model. Available online: https:\/\/miyazakienterprises.com\/miya-model\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1016\/j.injury.2021.04.045","article-title":"A pilot study to evaluate the face & construct validity of an orthopaedic virtual reality simulator","volume":"52","author":"Feeley","year":"2021","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pickham, D., Lohre, R., and Goel, D. (2022). Surgical device representatives preference for experiential learning via immersive virtual reality. J. Orthop. Exp. Innov., 3.","DOI":"10.60118\/001c.36131"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.jsurg.2022.06.007","article-title":"The utility of virtual reality in orthopedic surgical training","volume":"79","author":"Cevallos","year":"2022","journal-title":"J. Surg. Educ."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"947","DOI":"10.2147\/AMEP.S395087","article-title":"A comparative study of traditional technique guide versus virtual reality in orthopedic trauma training","volume":"14","author":"Lamb","year":"2023","journal-title":"Adv. Med. Educ. Pract."},{"key":"ref_24","unstructured":"FundamentalXR (2025, December 31). Roadmap to Success: Implementing Immersive XR Solutions for the Future of Ophthalmology, 2025. Available online: https:\/\/www.fundamentalxr.com\/news\/roadmap-to-success-implementing-immersive-xr-solutions-for-the-future-of-ophthalmology."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s11934-021-01043-z","article-title":"Innovations in urologic surgical training","volume":"22","author":"Ma","year":"2021","journal-title":"Curr. Urol. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Shrestha, A., and Giabbanelli, P.J. (2025). Are We Ready for Synchronous Conceptual Modeling in Augmented Reality? A Usability Study on Causal Maps with HoloLens 2. Information, 16.","DOI":"10.3390\/info16110952"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"425","DOI":"10.2307\/30036540","article-title":"User acceptance of information technology: Toward a unified view","volume":"27","author":"Venkatesh","year":"2003","journal-title":"MIS Q."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Junga, A., Schulze, H., Scherzer, S., H\u00e4tscher, O., Bozdere, P., Schmidle, P., Risse, B., Marschall, B., and The Medical tr.AI.ning Consortium (2024). Immersive learning in medical education: Analyzing behavioral insights to shape the future of VR-based courses. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-06337-7"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100441","DOI":"10.1016\/j.pecinn.2025.100441","article-title":"User evaluation of a virtual reality simulation for anaesthesiologists-intensivists for non-technical skills","volume":"7","author":"Hoek","year":"2025","journal-title":"PEC Innov."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1002\/jdd.12503","article-title":"Immersion and haptic feedback impacts on dental anesthesia technical skills virtual reality training","volume":"85","author":"Kira","year":"2021","journal-title":"J. Dent. Educ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e20.00019","DOI":"10.2106\/JBJS.OA.20.00019","article-title":"Left-Handedness Among Orthopaedic Surgeons and Trainees","volume":"5","author":"Sabharwal","year":"2020","journal-title":"JBJS Open Access"},{"key":"ref_32","unstructured":"Murphy, B. (2025, December 31). These Physician Specialties Have the Biggest Gender Imbalances. Available online: https:\/\/www.ama-assn.org\/medical-students\/specialty-profiles\/these-physician-specialties-have-biggest-gender-imbalances."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"104734","DOI":"10.1016\/j.amsu.2022.104734","article-title":"Impact of haptic feedback on surgical training outcomes: A randomised controlled trial of haptic versus non-haptic immersive virtual reality training","volume":"83","author":"Gani","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.nedt.2019.05.026","article-title":"Learning procedural skills with a virtual reality simulator: An acceptability study","volume":"79","author":"Bracq","year":"2019","journal-title":"Nurse Educ. Today"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1016\/j.jsurg.2023.08.012","article-title":"A Pilot Study Evaluating a Virtual Reality-Based Nontechnical Skills Training Application for Urology Trainees: Usability, Acceptability, and Impact","volume":"80","author":"Pears","year":"2023","journal-title":"J. Surg. Educ."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1145\/3265748","article-title":"Visual Analytics to Identify Temporal Patterns and Variability in Simulations from Cellular Automata","volume":"29","author":"Giabbanelli","year":"2019","journal-title":"ACM Trans. Model. Comput. Simul."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1007\/s00268-010-0933-2","article-title":"Do Soft Skills Predict Surgical Performance?","volume":"35","author":"Maschuw","year":"2011","journal-title":"World J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Scalf, P.E., Torralbo, A., Tapia, E., and Beck, D.M. (2013). Competition explains limited attention and perceptual resources: Implications for perceptual load and dilution theories. Front. Psychol., 4.","DOI":"10.3389\/fpsyg.2013.00243"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1007\/s00464-022-09740-7","article-title":"How does the modality of delivering force feedback influence the performance and learning of surgical suturing skills? We don\u2019t know, but we better find out! A review","volume":"37","author":"Oppici","year":"2023","journal-title":"Surg. Endosc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s10143-020-01314-2","article-title":"The impact of surgical simulation on patient outcomes: A systematic review and meta-analysis","volume":"44","author":"Meling","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jsurg.2019.09.006","article-title":"Systematic review of virtual haptics in surgical simulation: A valid educational tool?","volume":"77","author":"Rangarajan","year":"2020","journal-title":"J. Surg. Educ."}],"container-title":["Digital"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-6470\/6\/1\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T11:08:53Z","timestamp":1772449733000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-6470\/6\/1\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":41,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["digital6010018"],"URL":"https:\/\/doi.org\/10.3390\/digital6010018","relation":{},"ISSN":["2673-6470"],"issn-type":[{"value":"2673-6470","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}