Title : The virtual operating room: Building and evaluating VR/AR training for medical students and young neurosurgeons

Background: Virtual Reality (VR) and Augmented Reality (AR) are increasingly used to transform how surgical skills are taught. Within the LERCO project (Life Environment Research Center Ostrava), a multidisciplinary team of neurosurgeons, scrub nurses and IT developers is building VR- and AR-based training modules to improve the education of medical students and young neurosurgeons. This work presents the completion of additional training modules and the introduction of an evaluation of learners’ performance.

Methods: VR training is delivered on standalone Meta Quest 3 headsets within a digital twin of our operating room in Zlín, built using photogrammetry, with instruments modelled on our physical surgical sets. Each module follows a structured simulation logic: pre-procedural setup with patient-specific MRI, CT and fluoroscopy data, a guided step-by-step sequence with a real-time action panel, “must-pass” gating that prevents progression without mastering the current step, and immediate audio-visual feedback on errors. Five VR modules have been developed: vertebroplasty, insertion of an intracranial-pressure monitor, anterior cervical discectomy and fusion, carpal tunnel release, and craniotomy, now advancing toward a gamified framework with real-time completion-time tracking and error logging. In parallel, an AR module using a Magic Leap 2 headset combined with 3D-printed vertebrae trains transpedicular screw placement across the thoraco-lumbar and cervical spine, projecting entry-point markers and trajectory axes directly onto the physical bone while measuring entry error, angular deviation and procedural time.

Results: All VR modules and the AR spine module have now reached a training-ready or near-final stage, completing the module set outlined in our earlier work. The gamification and analytics framework is being extended across all modules to enable formal benchmarking of student performance against expert gold-standard data. Initial evaluation of medical students and young neurosurgeons shows improved 3D anatomical understanding, higher engagement, and a consistent, checklist-based training experience. Objective metrics, including entry error and completion time, are being collected to quantify learning-curve progression and error reduction, consistent with published evidence that VR-trained trainees perform faster and with fewer errors.

Conclusion: Completing this module set, together with structured, metrics-based student evaluation, marks a transition from an exploratory pilot toward a validated training platform. Future development will expand the clinical curriculum to emergency procedures, including evacuation of epidural and acute subdural haematomas and spinal fixation, add a high-fidelity module for external ventricular drain placement, and move from standard controllers toward haptic-feedback gloves to enable realistic tactile interaction. Overall, VR and AR continue to represent a significant step forward in neurosurgical education, safely bridging the gap between theoretical knowledge and the practical competence required of young neurosurgeons.

The project was supported by the Just Transition Operational Programme of the State Environmental Fund of the Czech Republic as part of the LERCO project (CZ.10.03.01/00/22_003/0000003).

Dr. Martin Kender is a medical doctor specializing in neurosurgery. He graduated in General Medicine from Palacký University in Olomouc in 2019 and currently works at the Tomáš Baťa Regional Hospital in Zlín, Czech Republic. Since 2023, alongside his clinical work, he has been involved in the LERCO project at the University of Ostrava, focusing on the development of virtual reality-based neurosurgical training modules, with a particular interest in simulation-based education and surgical skill acquisition. Since 2025, he has also been a PhD student at the Department of Neurosciences, Faculty of Medicine, University of Ostrava.