As virtual and augmented reality simulation technologies advance, the use of such technologies in medicine is widespread. The advanced virtual and augmented systems coupled with a complex interactive, immersive environment create a metaverse. The metaverse enables us to connect with others in a virtual world free of spatial restrictions and time constraints. In the educational aspect, it allows collaboration among peers and educators in an immersive 3D environment that can imitate the actual classroom setting with learning tools. Metaverse technology enables visualization of virtual 3D structures, facilitates collaboration and small group activities, improves mentor–mentee interactions, provides opportunities for self-directed learning experiences, and helps develop teamwork skills. The metaverse will be adapted rapidly in healthcare, boost digitalization, and grow in use in surgical procedures and medical education. The potential advantages of using the metaverse in diagnosing and treating patients are tremendous. This perspective paper provides the current state of technology in the medical field and proposes potential research directions to harness the benefits of the metaverse in medical education, research, and patient care. It aims to spark interest and discussion in the application of metaverse technology in healthcare and inspire further research in this area.

Background. Distractions are recognized as a significant factor affecting performance in safety critical domains. Although operating rooms are generally full of distractions, the effect of distractions on robot-assisted surgical (RAS) performance is unclear. Our aim was to investigate the effect of distractions on RAS performance using both objective and subjective measures. Methods. Fifteen participants performed a knot-tying task using the da Vinci Surgical System and were exposed to 3 distractions: (1) passive distraction entailed listening to noise with a constant heart rate, (2) active distraction included listening to noise and acknowledging a change of random heart rate from 60 to 120 bpm, and (3) interactive distraction consisted of answering math questions. The objective kinematics of the surgical instrument tips were used to evaluate performance. Electromyography (EMG) of the forearm and hand muscles of the participants were collected. The median EMG frequency (EMG_fmed) and the EMG envelope (EMG_env) were analyzed. NASA Task Load Index and Fundamentals of Laparoscopic Surgery score were used to evaluate the subjective performance. One-way repeated analysis of variance was applied to examine the effects of distraction on skills performance. Spearman’s correlations were conducted to compare objective and subjective measures. Results. Significant distraction effect was found for all objective kinematics measures ( P < .05). There were significant distraction effects for EMG measures (EMG_env, P < .004; EMG_fmed, P = .031). Significant distraction effects were also found for subjective measurements. Conclusions. Distraction impairs surgical skills performance and increases muscle work. Understanding how the surgeons cope with distractions is important in developing surgical education.

Laparoscopic cholecystectomy (LC) is the standard procedure for gallbladder removal, but improper identification of anatomical structures can lead to biliary duct injury (BDI). The critical view of safety (CVS) is a standardized technique designed to mitigate this risk. However, existing surgical training systems primarily emphasize haptic feedback and physical skill development, making them expensive and less accessible. This paper presents the next-generation Portable Camera-Aided Surgical Simulator (PortCAS), a cost-effective, portable, vision-based surgical training simulator designed to enhance cognitive skill acquisition in LC. The system consists of an enclosed physical module equipped with a vision system, a single-board computer for real-time instrument tracking, and a virtual simulation interface that runs on a user-provided computer. Unlike traditional simulators, PortCAS prioritizes cognitive training over force-based interactions, eliminating the need for costly haptic components. The system was evaluated through user studies assessing accuracy, usability, and training effectiveness. Results demonstrate that PortCAS provides a sufficiently accurate tracking performance for training surgical skills such as CVS, offering a scalable and accessible solution for surgical education.

(1) Medical training is changing, especially for surgeons. Virtual reality simulation is an excellent way to train surgeons safely. Studies show that surgeons who train with simulation have demonstrated improved technical skills in fundamental surgical procedures. The purpose of this study is to determine the overall impact of virtual reality training on laparoscopic cholecystectomy performance and to explore whether specific training protocols or the addition of feedback confer any advantages for future surgeons. (2) MEDLINE (PubMed), Embase (Ovid SP), Web of Science, Google Scholar, and Scopus were searched for the literature related to virtual reality training, immersive simulation, laparoscopic surgical skills training, and medical education. Study quality was assessed using the Cochrane Risk of Bias Tool and NIH Quality Assessment Tool. (3) A total of 55 full-text articles were reviewed. Meta-analysis showed that virtual reality training is an effective method for learning cholecystectomy surgical skills. (4) Conclusions: Performance, measured by objective structured assessments and time to task completion, is improved with virtual reality training compared with no additional training. Positive effects of simulation training were evident in global rating scores and operative time. Continuous feedback on movement parameters during laparoscopic cholecystectomy skills training impacts skills acquisition and long-term retention.

This study determined the muscle effort and fatigue of the upper extremity while performing fundamental surgical skills training tasks. Ten novices performed three tasks (precision cutting, needle passing, and peg transfer) using either a virtual simulator or a laparoscopic box-trainer. Their electromyography (EMG) activities in both proximal and distal parts of upper extremity were measured. Significantly more muscle effort were required to complete tasks with the box-trainer, whereas similar muscle fatigue levels between tasks were found in both training environments. These EMG results demonstrated how the virtual trainer could provide meaningful physiological value to the surgeon training in laparoscopic surgery.