Andrea Quaiattini

Background Virtual simulations (VSs) enhance clinical competencies and skills. However, a previous systematic review of 9 RCT studies highlighted a paucity of literature on the effects of haptic feedback in surgical VSs. An updated systematic and scoping review was conducted to encompass more studies and a broader range of study methodologies. Methods A systematic literature search was conducted on July 31, 2023, in MEDLINE, Embase, and Cochrane. English language studies comparing haptic vs non-haptic conditions and using VSs were included. Studies were evaluated and reported using PRISMA-ScR guidelines. Results Out of 2782 initial studies, 51 were included in the review. Most studies used RCT (21) or crossover (23) methodologies with medical residents, students, and attending physicians. Most used post-intervention metrics, while some used pre- and post-intervention metrics. Overall, 34 performance results from studies favored haptics, 3 favored non-haptics, and the rest showed mixed or equal results. Conclusion This updated review highlights the diverse application of haptic technology in surgical VSs. Haptics generally enhances performance, complements traditional teaching methods, and offers personalized learning with adequate simulator validation. However, a sparsity of orienting to the simulator, pre-/post-study designs, and small sample sizes poses concerns with the validity of the results. We underscore the urgent need for standardized protocols, large-scale studies, and nuanced understanding of haptic feedback integration. We also accentuate the significance of simulator validation, personalized learning potential, and the need for researcher, educator, and manufacturer collaboration. This review is a guidepost for navigating the complexities and advancements in haptic-enhanced surgical VSs.