Objectives: In recent years, consumer-grade immersive virtual reality (iVR) systems have gained increasing attention for their potential applications in surgical training. The relatively low cost and increasing quality of these systems make them an appealing alternative to specialist surgical simulators, but their efficacy in comparison to traditional training techniques remains unclear. In this paper, we systematically review the recent literature comparing the impact of iVR-based and other training techniques on surgical proficiency. Method: Five databases (Ovid MEDLINE, PsycINFO, EMBASE, Cochrane Library, Web of Science) were searched from 2016 to November 2023. 19 randomised controlled trials (totalling 593 participants) were identified as meeting the inclusion criteria for this review, involving trainee surgical participants being trained using iVR devices. Results: Data from the 19 articles showed that iVR training was at least as effective as other simulation-based methods and more effective than conventional methods at improving key measures of surgical proficiency, including error rate, accuracy, and procedure-specific knowledge, with a short duration (20 minutes to 2 hours) being optimal. While these results demonstrate the potential of iVR-based training technologies to support effective and low-cost surgical skill training, the heterogeneity of the training tools and analysis methods used in the identified studies limits mechanistic explanations of the systems efficacy. Conclusions: To support more robust and generalisable research into iVR surgical skill training, we make recommendations for the design and reporting of future intervention studies in this area. This notably involves the standardisation of an iVR definition, improvements to studies including consideration of personal experiences, and considering the long-term impacts of these interventions.

The authors have declared no competing interest.

This research is funded by the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (BRC) (NIHR203331). Author FM is further supported by the European Union's Horizon Research and Innovation programme under grant agreement number 101070155 and the UKRI through the Horizon Europe Guarrantee (#10039307)

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