The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial

Published:October 29, 2022DOI:



      The purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery.


      A prospective, parallel two-armed, randomized controlled trial.


      Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2), before and after the VR application.


      The VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO2 (P = .019) values) compared to the levels in the control group.


      VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.


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        • Altun Ugras G
        • Yıldırım G
        • Yüksel S
        • Oztürkçü Y
        • Kuzdere M
        • Oztekin SD
        The effect of different types of music onpatients' preoperative anxiety: a randomized controlled trial.
        Complement Ther in Clin Pract. 2018; 31: 158-163
        • Mulugeta H
        • Ayana M
        • Sintayehu M
        • Dessie G
        • Zewdu T
        Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia.
        BMC Anesthesiol. 2018; 18: 155
        • Stamenkovic DM
        • Rancic NK
        • Latas MB
        • et al.
        Preoperative anxiety and implications on postoperative recovery: what can we do to change our history.
        Minerva Anestesiol. 2018; 84: 1307-1317
        • Ganry L
        • Hersant B
        • Sidahmed-Mezi M
        • Dhonneur G
        • Meningaud JP.
        Using virtual reality to control preoperative anxiety in ambulatory surgery patients: a pilot study in maxillofacial and plastic surgery.
        J Stomatol Oral Maxillofac Surg. 2018; 119: 257-261
        • Sahin G
        • Basak T.
        The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: a randomized controlled trial.
        J Perianesth Nurs. 2020; 35: 269-276
        • Clair C
        • Engström Å
        • Strömbäck U.
        Strategies to relieve patients' preoperative anxiety before anesthesia: experiences of nurse anesthetists.
        J Perianesth Nurs. 2020; 35: 314-320
        • Koo CH
        • Park JW
        • Ryu JH
        • Han SH.
        The effect of virtual reality on preoperative anxiety: a meta-analysis of randomized controlled trials.
        J Clin Med. 2020; 9: 3151
        • Robertson A
        • Khan R
        • Fick D
        • Robertson WB
        • Gunaratne DR
        • Yapa S
        • et al.
        The effect of Virtual Reality in reducing preoperative anxiety in patients prior to arthroscopic knee surgery: A randomised controlled trial.
        in: 2017 IEEE 5th International Conference on Serious Games and Applications for Health (SeGAH), April 2017, at the Perth Convention and Exhibition Centre, Perth, Western Australia. 2017: 1-7
        • Townsend MC.
        Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice.
        6th Edition. FA Davis, Philadelphia2016
        • Videbeck S.L.
        Psychiatric-Mental Health Nursing.
        8th Edition. Lippincott Williams & Wilkins, China2019
        • Kipnis G
        • Tabak N
        • Koton S.
        Background music playback in the preoperative setting: does it reduce the level of preoperative anxiety among candidates for elective surgery?.
        J Perianesth Nurs. 2016; 31: 209-216
        • McClurkin SL
        • Smith CD.
        The duration of self-selected music needed to reduce preoperative anxiety.
        J Perianesth Nurs. 2016; 31: 196-208
        • İbrahimoğlu Ö
        • Kanan N.
        The effect of progressive muscle relaxation exercises after endotracheal extubation on vital signs and anxiety level in open heart surgery patients.
        Turk J Intensive Care. 2017; 15: 98-106
        • Çınar H
        • Çam R.
        The effects of progressive relaxation method on the patients applied total knee arthroplasty.
        Med Sci Discovery. 2018; 5: 380-389
        • Essa RM
        • Ismail NIAA
        • Hassan NI.
        Effect of progressive muscle relaxation technique on stress, anxiety, and depression after hysterectomy.
        J Nurs Educ Pract. 2017; 7: 77-86
        • Dehghan F
        • Jalali R
        • Bashiri H.
        The effect of virtual reality technology on preoperative anxiety in children: a solomon four-group randomized clinical trial.
        Periop Med. 2019; 8: 1-7
        • Üzümcü E
        • Akın B
        • Nergiz H
        • İnözü M
        • Çelikcan U.
        Virtual reality for anxiety disorders.
        Current Approaches Psychiatr. 2018; 10: 99-117
        • Eijlers R
        • Dierckx B
        • Staals LM
        • et al.
        Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial.
        Eur J Anesthesiol. 2019; 36: 728-737
        • Kim Y
        • Kim H
        • Kim YO.
        Virtual reality and augmented reality in plastic surgery: a review.
        Arch of Plast Surg. 2017; 44: 179-187
        • Khadra C
        • Ballard A
        • Dery J
        • et al.
        Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: a pilot study.
        J Pain Res. 2018; 14: 343-353
        • Mosso-Vázquez JL
        • Gao K
        • Wiederhold BK
        • Wiederhold MD.
        Virtual reality for pain management in cardiac surgery.
        Cyberpsychol Behav Soc Netw. 2014; 17: 371-378
        • Wiederhold BK
        • Soomro A
        • Riva G
        • Wiederhold MD.
        Future directions: advances and implications of virtual environments designed for pain management.
        Cyberpsychol Behav Soc Netw. 2014; 17: 414-422
        • Scheffler M
        • Koranyi S
        • Meissner W
        • Straub B
        • Rosendahl J.
        Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: a systematic review and meta-analysis of randomized controlled trials.
        Burns. 2017; 44: 1709-1720
        • Scapin SQ
        • Echevarria-Guanilo ME
        • Boeria PR
        • Martins JC
        • Barbosa MV
        • Lopes Pereima MJ
        Use of virtual reality for treating burned children: case reports.
        Rev Bras Enferm. 2017; 70: 1291-1295
        • Carrougher G J
        • Hoffman HG
        • Nakamura D
        • et al.
        The effect of virtual reality on pain and range of motion in adults with burn injuries.
        J Burn Care Res. 2009; 30: 785-791
        • Hoffman HG
        • Chambers GT
        • Meyer WJ
        • et al.
        Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures.
        Ann Behav Med. 2011; 41: 183-191
        • Chan PY
        • Scharf S.
        Virtual reality as an adjunctive nonpharmacological sedative during orthopedic surgery under regional anesthesia: a pilot and feasibility study.
        Anesth Analg. 2017; 125: 1200-1202
        • Yang JH
        • Ryu JJ
        • Nam E
        • Lee HS
        • Lee K
        Effects of preoperative virtual reality magnetic resonance imaging on preoperative anxiety in patients undergoing arthroscopic knee surgery: a randomized controlled study.
        Arthroscopy. 2019; 35: 2394-2399
        • Bekelis K
        • Calnan D
        • Simmons N
        • MacKenzie TA
        • Kakoulides G.
        Effect of an immersive preoperative virtual reality experience on patient-reported outcomes: a randomised controlled trial.
        Ann Surg. 2017; 265: 1068-1073
        • Dayılar H
        • Oyur G
        • Kamer E
        • Sarıçiçek A
        • Cengiz F
        • Hacıyanlı M.
        Evaluation of anxiety levels of patients before colon surgery.
        Turkish J Colorectal Dis. 2017; 27: 6-10
        • Lafci A
        • Gokcinar D
        • Dag O.
        Identifying surgery and anesthesia-related anxiety in patients undergoing colorectal cancer surgery.
        Int J Anesthesia Res. 2018; 6: 550-554
        • Yang Y
        • Sun G
        • Dong X
        • Zhang H
        • Xing C
        • Liu Y.
        Preoperative anxiety in Chinese colorectal cancer patients: the role of social support, self-esteem and coping styles.
        J Psychosom Res. 2019; 121: 81-87
        • Talebi-Azar N
        • Bagherzadi A
        • Soltannejad M
        • et al.
        Evaluation of anxiety level and its related factors in patients undergoing inguinal hernia surgery; a descriptive-correlation study.
        Annals of RSCB. 2021; : 19172-19180
        • Kavak Akelma F
        • Altınsoy S
        • Arslan MT
        • Ergil J.
        Effect of favorite music on postoperative anxiety and pain.
        Anaesthesist. 2020; 69: 198-204
        • Bayraktar N
        • Berhuni O
        • Berhuni MS
        • Zeki O
        • Sener ZT
        • Sertbas G.
        Effectiveness of lifestyle modification education on knowledge, anxiety, and postoperative problems of patients with benign perianal diseases.
        J Perianesth Nurs. 2018; 33: 640-650
        • Gorad KP
        • Tonape T
        • Patil S
        • Gautam R
        • Lohar H.
        Modified Bassini's repair: Our experience in a rural hospital setup.
        Med J DY Patil Univ. 2013; 6: 378
        • Bartlett JE
        • Kotrlik JW
        • Higgins CC.
        Organizational research: determining appropriate sample size in survey research.
        Informat Technol Learn Performance J. 2001; 19: 43-50
        • Karanci AN
        • Dirik G.
        Predictors of pre-and postoperative anxiety in emergency surgery patients.
        J Psychosom Res. 2003; 55: 363-369
        • Taber KS.
        The use of cronbach's alpha when developing and reporting research instruments in science education.
        Res Sci Educ. 2018; 48: 1273-1296
        • Hoxhallari E
        • Behr IJ
        • Bradshaw JS
        • et al.
        Virtual reality improves the patient experience during wide-awake local anesthesia no tourniquet hand surgery: a single-blind, randomized, prospective study.
        Plast Reconstr Surg. 2019; 144 (408-141)
        • Mifflin KA
        • Hackmann T
        • Chorney JM.
        Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia.
        Anesth Analg. 2012; 115: 1162-1167
        • World Medical Association
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
        • Bansal T
        • Joon A.
        Preoperative anxiety- an important but neglected issue: a narrative review.
        Indian Anasesthetists’ Forum. 2016; 17: 37-42
        • Gezer D
        • Arslan S.
        The effect of education on the anxiety level of patients before thyroidectomy.
        J Perianesth Nurs. 2019; 34: 265-271
        • Baran O
        • Mordeniz C
        • Arar MC
        • Günkaya M.
        The effect of video information on preoperative anxiety levels in patients undergoing total knee replacement.
        J Academic Res Med. 2020; 10: 122-128
        • Al-Nerabieah Z
        • Alhalabi MN
        • Owayda A
        • Alsabek L
        • Bshara N
        • Kouchaji C.
        Effectiveness of using virtual reality eyeglasses in the waiting room on preoperative anxiety: A randomized controlled trial.
        Perioperat Care Operat Room Manag. 2020; 21100129
        • Hendricks TM
        • Gutierrez CN
        • Stulak JM
        • Dearani JA
        • Miller JD.
        The use of virtual reality to reduce preoperative anxiety in first-time sternotomy patients: a randomized controlled pilot trial.
        Mayo Clin Proc. 2020; 95: 1148-1157
        • İnal S
        • Canbulat N.
        Using of distraction methods on procedural pain management of pediatric patients.
        Arch Health Sci Res. 2015; 13: 16-21
        • Fadeev KA
        • Smirnov AS
        • Zhigalova O P
        • Bazhina PS
        • Tumialis AV
        • Golokhvast KS.
        Too real to be virtual: autonomic and eeg responses to extreme stress scenarios in virtual reality.
        Behav Neurol. 2020; 12: 1-11
        • Baytar Ç
        • Bollucuoğlu K.
        Effect of virtual reality on preoperative anxiety in patients undergoing septorhinoplasty [In Press].
        Braz J Anesthesiolfi. 2021;
        • Riches S
        • Azevedo L
        • Bird L
        • Pisani S
        • Valmaggia L.
        Virtual reality relaxation for the general population: a systematic review.
        Soc Psychiatry Psychiatr Epidemiol. 2021; 56: 1707-1727
        • Mazgelytė E
        • Rekienė V
        • Dereškevičiūtė E
        • et al.
        Effects of virtual reality-based relaxation techniques on psychological, physiological, and biochemical stress ındicators.
        Healthcare. 2021; 9: 1729
        • Biddiss E
        • Knibbe TJ
        • McPherson A.
        The effectiveness of interventions aimed at reducing anxiety in health care waiting spaces: a systematic review of randomized and nonrandomized trials.
        Anesth Analg. 2014; 119: 433-448
        • Pittman S
        • Kridli S.
        Music intervention and preoperative anxiety: an integrative review.
        Int Nurs Rev. 2011; 58: 157-163