Validity assessment for technical skills and stress management of the HelpMeSee ® Manual Small Incision Cataract Surgery module

PURPOSE: To assess the validity of the HelpMeSee Manual Small Incision Cataract Surgery (MSICS) module as a virtual reality training tool for technical skills and stress management in ophthalmology. METHODS: This prospective study enrolled 47 volunteer surgeons from five groups: four groups of eye surgeons with increasing experience (novice, junior, senior and expert) and a fifth group of experts from other specialties. Participants completed two standardized MSICS training runs on the HelpMeSee simulator. Performance scores, penalties and completion time were recorded. Ergonomics were assessed via the Rapid Upper Limb Assessment (RULA) score, and stress was evaluated subjectively and objectively using the State-Trait Anxiety Inventory-Y (STAI-Y) and the Analgesia Nociception Index (ANI) score. Data from the two runs were analysed and compared across groups. RESULTS: Overall scores increased significantly from novice residents (32.4 ± 10.7 out of 72) to the expert ophthalmic surgeons (50.1 ± 9.41) (p < 0.001). Non-ophthalmic experts had a lower mean score (16.8 ± 18.0). Total penalties, particularly in the second run, decreased with experience among eye surgeons, while experts from other specialties incurred the highest penalties. Time analysis did not differ between groups, as for RULA or STAI-Y scores. The mean ANI score decreased with experience, suggesting higher stress levels in more experienced participants. CONCLUSIONS: The HelpMeSee MSICS module effectively differentiates surgical experience levels, confirming its validity as a tool for technical skills training. The ANI score demonstrated modified behaviour in expert surgeons, suggesting the simulator's potential for assessing non-technical skills. These findings support the use of this virtual reality simulator for objective, skills-based surgical education.