Mixed reality-based training simulator for learning scope maneuvering skills in hysteroscopy

Abstract Scope maneuvering skills are essential for performing hysteroscopy. Conventional methods using synthetic or animal models provide limited training value due to lack of realism, while virtual reality simulators can be prohibitively expensive. In this work we present a low-cost, portable, Mixed Reality (MR) based hysteroscopy simulator. The prototype was developed using a Head-Mounted Display (HMD) device (Meta Quest 3), and 3D printed components designed to simulate scope movements. When observed through using the pass-through feature of the HMD device, virtual elements (including the operating table, screen displaying a dynamic operative field, virtual patient, and surgical scope system) were spatially rendered around the operator. To evaluate the prototype, a user study was conducted using a real scope and the MR simulator. Subjects completed a training phase (10 trials) followed by a validation phase (2 trials), during which various outcomes were measured to assess the impact of the training environment. Training using the MR simulator was comparable to training using the real scope, resulting in similar completion times during validation trials. Perceived workload (measured using SURG-TLX scores) decreased over repeated trials, showing no significant variation between environments. Feeback survey indicated equivalent learning, confidence, and perceived usefulness in both training environments. We conclude that a low-cost simulator is feasible with MR technology. The simulator generates a realistic and immersive environment mimicking both the operating room and the operative field, enabling hands-on training to learn the hand-eye coordination skills required for maneuvering a scope during hysteroscopy.