Virtual surgical training systems are crucial for enabling mental preparation, supporting decision-making, and improving surgical skills. Many virtual surgical training environments focus only on training for a specific medical skill and take place in a single virtual room. However, surgical education and training include the planning of procedures as well as interventions in the operating room context. Moreover, collaboration among surgeons and other medical professionals is only applicable to a limited extent. This work presents a collaborative VR environment similar to a virtual teaching hospital to support surgical training and interprofessional collaboration in a co-located or remote environment. The environment supports photo-realistic avatars and scenarios ranging from planning to training procedures in the virtual operating room. It includes a lobby, a virtual surgical planning room with four surgical planning stations, laparoscopic liver surgery training with the integration of laparoscopic surgical instruments, and medical training scenarios for interprofessional team training in a virtual operating room. Each component was evaluated by domain experts as well as in a series of user studies, providing insights on usability, usefulness, and potential research directions. The proposed environment may serve as a foundation for future medical training simulators.

One of the biggest challenges in using ultrasound (US) is learning to create a spatial mental model of the interior of the scanned object based on the US image and the probe position. As intraoperative ultrasound (IOUS) cannot be easily trained on patients, we present LiVRSono, an immersive VR application to train this skill. The immersive environment, including an US simulation with patientspecific data as well as haptics to support hand-eye coordination, provides a realistic setting. Four clinically relevant training scenarios were identified based on the described learning goal and the workflow of IOUS for liver. The realism of the setting and the training scenarios were evaluated with eleven physicians, of which six participants are experts in IOUS for liver and five participants are potential users of the training system. The setting, handling of the US probe, and US image were considered realistic enough for the learning goal. Regarding the haptic feedback, a limitation is the restricted workspace of the input device. Three of the four training scenarios were rated as meaningful and effective. A pilot study regarding learning outcome shows positive results, especially with respect to confidence and perceived competence. Besides the drawbacks of the input device, our training system provides a realistic learning environment with meaningful scenarios to train the creation of a mental 3D model when performing IOUS. We also identified important improvements to the training scenarios to further enhance the training experience.

We present a Virtual and Augmented Reality multi-user prototype of a learning environment for liver anatomy education. Our system supports various training scenarios ranging from small learning groups to classroom-size education, where students and teachers can participate in virtual reality, augmented reality, or via desktop PCs. In an iterative development process with surgeons and teachers, a virtual organ library was created. Nineteen liver data sets were used comprising 3D surface models, 2D image data, pathology information, diagnosis and treatment decisions. These data sets can interactively be sorted and investigated individually regarding their volumetric and meta information. The three participation modes were evaluated within a user study with surgery lecturers (5) and medical students (5). We assessed the usability and presence using questionnaires. Additionally, we collected qualitative data with semistructured interviews. A total of 435 individual statements were recorded and summarized to 49 statements. The results show that our prototype is usable, induces presence, and potentially support the teaching of liver anatomy and surgery in the future.