A Novel Surgical Skills Training Methodology, Leveraging Virtual Reality and Haptics to Teach Retropubic Midurethral Slings: Usability, Performance Validation, and Assessment Capability

INTRODUCTION: Simulation-based training remains underdeveloped in surgical education for soft-tissue procedures, which are primarily learned by tactile feedback. Traditional methods rely on cadaver labs or patient-based learning, which are costly, geographically limited, and raise ethical questions. Virtual reality (VR) with haptic feedback offers a scalable alternative, but most current platforms emphasize bone-based procedures or require instructor facilitation. We developed a novel, portable VR+haptics simulator for preoperative training of retropubic midurethral sling (MUS) surgery. OBJECTIVE: To evaluate the usability, validity, and assessment potential of a novel training system by both trainees and expert surgeons. METHODS: Our mixed-methods study included 11 gynecologic surgery trainees (residents and fellows) and 13 expert surgeons who performed MUS procedures using the novel platform (Figure 1). After familiarization, participants completed the procedure across four levels of increasing difficulty. We recorded objective performance scores and the number of attempts to complete each level, then administered a survey adapted from validated usability questionnaire (UTAUT) to assess performance expectancy, effort expectancy, social influence, behavioral intention along with items on tactile realism and authenticity, and NASA Task Load Index (NASA-TLX) workload ratings. Data were analyzed for central tendencies, group differences, and associations between workload and skill training progression. RESULTS: Trainees reported high usability and acceptability. All (100%) agreed that the VR+haptics training platform allowed them to make mistakes and learn safely, and all preferred a blended approach combining VR+haptics with cadaver labs over traditional methods alone. Trainees strongly endorsed immersion (100%) and engagement (100%). Experts agreed the platform is valuable for sling training (92%) and endorsed its potential for skill assessment (92%), although they were less likely than trainees to affirm tactile realism or cadaveric authenticity (31%) (Table 1). This divergence may reflect iterative improvements to the system across cohorts or the higher sensitivity of experts accustomed to real surgical environments. The system showed construct validity with scoring system distinguishing skill level where experts significantly outperformed trainees across all four levels (expert mean scores 81.5-88.6 vs Trainees, 51.2−56.7, p<0.003 for all comparisons: Table 2). In the NASA-TLX, trainees reported very low physical and temporal demand (10 and 15), low frustration (30) and mental demand (35), neutral effort (50). Self-rated performance success was somewhat high (65). Regression analyses confirmed significant associations between mental demand, effort, and frustration with level progression and number of attempts (all p<0.0001, Table 3). Frustration was elevated in early attempts but decreased as users progressed, suggesting adaptation to the VR environment. A minority of participants reported persistently high frustration, potentially reflecting individual discomfort with VR rather than inherent system limitations. CONCLUSIONS: The haptics+VR surgical training system for retropubic midurethral slings was judged usable and engaging by trainees, supported by high acceptance on UTAUT measures, appropriate workload ratings, and strong intention to adopt similar systems. Face, Content, and Construct Validity were demonstrated. Overall, this novel platform is feasible for pre-OR training, combining usability, validity, and objective assessment. Expert and trainee’s performance scores support the platform’s capacity to define and measure proficiency levels in future work.Figure 1Table 1Table 2Table 3