Currently, surgical skills teaching in medical schools and hospitals is changing, requiring the development of new tools to focus on (i) the importance of the mentor’s role, (ii) teamwork skills training, and (iii) remote training support. Collaborative Networked Virtual Surgical Simulators (CNVSS) allow collaborative training of surgical procedures where remotely located users with different surgical roles can take part in the training session. To provide successful training involving good collaborative performance, CNVSS should guarantee synchronicity in time of the surgical scene viewed by each user and a quick response time which are affected by factors such as users’ machine capabilities and network conditions. To the best of our knowledge, the impact of these factors on the performance of CNVSS implementing hybrid client–server architecture has not been evaluated. In this paper the development of a CNVSS implementing a hybrid client–server architecture and two statistical designs of experiments (DOE) is described by using (i) a fractional factorial DOE and (ii) a central composite DOE, to determine the most influential factors and how these factors affect the collaboration in a CNVSS. From the results obtained, it was concluded that packet loss, bandwidth, and delay have a larger effect on the consistency of the shared virtual environment, whereas bandwidth, server machine capabilities, and delay and interaction between factors bandwidth and packet loss have a larger effect on the time difference and number of errors of the collaborative task.

Stand-alone and networked surgical simulators based on virtual reality have been proposed as a means to train surgeons in specific surgical skills with or without expert guidance and supervision. However, a surgical operation usually involves a group of medical practitioners who cooperate as team members. To this end, CNVSS have been proposed for the collaborative training of surgical procedures in which users with different surgical roles can take part in the training session. To be successful, these simulators should guarantee synchronicity, which requires (1) consistent viewing of the surgical scene and (2) a quick response time. These two variables are affected by factors such as users' machine capabilities and network conditions. As far as we know, the impact of these factors on the performance of CNVSS has not been evaluated. In this paper, we describe the development of CNVSS and a statistical factorial design of experiments (DOE) to determine the most important factors affecting collaboration in CNVSS. From the results obtained, it was concluded that delay, jitter, packet loss percentage, and processor speed have a major impact on collaboration in CNVSS.