Importance Retropubic midurethral slings (RP-MUS) are placed utilizing external anatomic landmarks and tactile sensation as the trocar creates a pathway from vaginal entry-dissection to suprapubic exit-site. Training a novice in virtual reality (VR) to achieve expert-level surgical skills can avoid the need for models, cadavers, or practicing on patients, but it relies on the existence of clear and replicable expert-level pathways. Objective The objective of this study was to determine whether surgical motion and haptic feedback from experts can clearly distinguish performances from novice learners. Study Design We tracked the motion and haptic feedback for novice medical students and board-certified urogynecologists as they performed RP-MUS surgery in VR. We measured differences using change of acceleration (jerk), similarity scores, and the number of clusters per participant group. Using a t -test, we examined differences between skill levels (expert vs. novice) in mean, magnitude, and jerk frequency scores. Results Eight experts and 16 novices participated in the study. Surgical pathways were less variable in experts versus novices, as indicated by fewer clusters for experts than novices (hand motion: 4 vs 18 clusters, head motion: 3 vs 17, haptic force: 6 vs 25). Overall, maximum motion-distance was also higher for novices than experts. Experts had more deliberate, efficient, smoother paths. T -tests found significant differences between experts and novices on time to complete the surgical simulation and jerk scores (hand motion and haptic pressure applied). Conclusions Across all measures, experts produced fewer sudden movements, demonstrated more consistent and purposeful motion, and completed tasks more efficiently. Although some metrics—such as cluster mean jerk and axis coordination—did not always reach statistical significance, they showed very large effect sizes favoring expert performance. Taken together, these results underscore that experts consistently outperform novices across both quantitative and qualitative assessments of procedural motion. Motion metrics can thus provide feedback for surgical training.
Siff et al. (Mon,) studied this question.