Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, 3-954, Toronto, ON M5G 2M9, Canada.
Surg Endosc. 2013 Feb;27(2):454-61. doi: 10.1007/s00464-012-2457-3. Epub 2012 Jul 26.
Advanced image-guidance systems allowing presentation of three-dimensional navigational data in real time are being developed enthusiastically for many medical procedures. Other industries, including aviation and the military, have noted that shifting attention toward such compelling assistance has detrimental effects. Using the detection rate of unexpected findings, we assess whether inattentional blindness is significant in a surgical context and evaluate the impact of on-screen navigational cuing with augmented reality.
Surgeons and trainees performed an endoscopic navigation exercise on a cadaveric specimen. The subjects were randomized to either a standard endoscopic view (control) or an AR view consisting of an endoscopic video fused with anatomic contours. Two unexpected findings were presented in close proximity to the target point: one critical complication and one foreign body (screw). Task completion time, accuracy, and recognition of findings were recorded.
Detection of the complication was 0/15 in the AR group versus 7/17 in the control group (p = 0.008). Detection of the screw was 1/15 (AR) and 7/17 (control) (p = 0.041). Recognition of either finding was 12/17 for the control group and 1/15 for the AR group (p < 0.001). Accuracy was greater for the AR group than for the control group, with the median distance from the target point measuring respectively 2.10 mm (interquartile range [IQR], 1.29-2.37) and 4.13 (IQR, 3.11-7.39) (p < 0.001).
Inattentional blindness was evident in both groups. Although more accurate, the AR group was less likely to identify significant unexpected findings clearly within view. Advanced navigational displays may increase precision, but strategies to mitigate attentional costs need further investigation to allow safe implementation.
许多医学程序都在积极开发能够实时呈现三维导航数据的高级图像引导系统。包括航空和军事在内的其他行业已经注意到，将注意力转移到这种引人注目的辅助工具上会产生不利影响。我们利用对意外发现的检测率来评估在手术环境中是否存在疏忽性失明，并评估增强现实的屏幕导航提示的影响。
外科医生和受训者在尸体标本上进行了内镜导航练习。参与者被随机分配到标准内镜视图（对照组）或由与解剖轮廓融合的内镜视频组成的 AR 视图。在目标点附近呈现了两个意外发现：一个关键并发症和一个异物（螺丝）。记录任务完成时间、准确性和发现的识别情况。
AR 组中并发症的检出率为 0/15，而对照组为 7/17（p = 0.008）。在 AR 组中检测到螺丝的为 1/15（AR），而在对照组中为 7/17（p = 0.041）。对照组中对两种发现的识别率分别为 12/17，而 AR 组为 1/15（p <0.001）。AR 组的准确性大于对照组，目标点的中位数距离分别为 2.10 毫米（四分位距[IQR]，1.29-2.37）和 4.13 毫米（IQR，3.11-7.39）（p <0.001）。
在两组中都存在疏忽性失明。尽管 AR 组更准确，但在视图内识别明显的意外发现的可能性较小。先进的导航显示可以提高精度，但需要进一步研究减轻注意力成本的策略，以实现安全实施。
