Training-transfer validation of a portable VR laparoscopic simulator: 6-DoF kinematic assessment on a common physical reference task

Portable consumer-headset virtual reality (VR) simulators can broaden access to instrumented surgical training, but their value depends on whether skills acquired in VR transfer beyond the immersive environment. We evaluated SECMA, a portable VR laparoscopic simulator, against conventional box-trainer practice using a common instrumented physical reference task. The analysis comprises $$N=18$$ participants (9 SECMA, 9 box trainer) and 66 unique PRE/POST 6-DoF assessment trials. Position and quaternion streams underwent timestamp-level quality control, gap segmentation, quaternion sign-continuity correction, and quaternion-consistent angular reconstruction. Primary outcomes were execution time, 3-D path length, and 95th-percentile angular speed. Both arms showed large PRE–POST reductions in execution time and path length. HC3-robust ANCOVA yielded baseline-adjusted SECMA-minus-box POST contrasts of $$-3.54$$ s, $$-0.446$$ m, and 0.0076 rad/s, respectively, with all 95% confidence intervals spanning zero and no systematic SECMA penalty in the adjusted point estimates. Strict equivalence was not established at the conservative $$0.2\\,SD_{PRE}$$ TOST margin because the observed intervals remained wider than the equivalence regions. A secondary posterior-predictive design simulation, fitted only to the observed cohort, quantified how margin choice and sample size affect confirmatory equivalence without inflating the experimental sample. Taken together, the observed data provide strong task-specific evidence of physical-task improvement following SECMA practice and a measurement-aware framework for determining the precision required for future confirmatory validation.