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Basic task simulations give the trainee opportunity to experience a variety of surgical complications, such as bleeding, dropping clips, and repercussion from rough tissue handling while benefiting from instant and more objective motion metrics feedback and suggestions on how to proceed. Other advantages of VR simulation are that modules contain detailed instruction for performance of all tasks and summative feedback comparing the overall performance with an expert level. The summative performance is also broken down into a number of performance metrics, such as time, instrument path length for the dominant and nondominant hands, and errors, giving objective information about the performance. Therefore, the provided feedback of VR gives the trainee opportunity to practice without the need for an instructor. We have found that this instant feedback also serves as motivation because most surgeons and residents have competitive personalities and enjoy the comparison with expert level.

At present, a number of VR simulators are commercially available, but they all carry the disadvantage of being expensive. Costs range from $28 000 (LapSim Essence) to over $90 000 for units with haptic feedback (LapSim haptic, Surgical Science, Minneapolis, MN) (personal communication, Martin Jansson, GM, Surgical Science, Inc., June 2020), and software updates are also expensive. Another disadvantage is that, as mentioned, all VR simulation is based on human anatomy, and developing software for veterinary simulation is expensive; such models may not become available, at least not in the near future.