使用视觉引导和性能参数的虚拟超声乳化手术模拟作为一种可行的熟练程度评估工具。
Virtual phacoemulsification surgical simulation using visual guidance and performance parameters as a feasible proficiency assessment tool.
作者信息
Lam Chee Kiang, Sundaraj Kenneth, Sulaiman Mohd Nazri, Qamarruddin Fazilawati A
机构信息
School of Mechatronic Engineering, Universiti Malaysia Perlis (UniMAP), Kampus Pauh Putra, 02600, Arau, Perlis, Malaysia.
Faculty of Electronics and Computer Engineering, Universiti Teknikal Malaysia Melaka (UTeM), Hang Tuah Jaya, 76100, Durian Tunggal, Melaka, Malaysia.
出版信息
BMC Ophthalmol. 2016 Jun 14;16:88. doi: 10.1186/s12886-016-0269-2.
BACKGROUND
Computer based surgical training is believed to be capable of providing a controlled virtual environment for medical professionals to conduct standardized training or new experimental procedures on virtual human body parts, which are generated and visualised three-dimensionally on a digital display unit. The main objective of this study was to conduct virtual phacoemulsification cataract surgery to compare performance by users with different proficiency on a virtual reality platform equipped with a visual guidance system and a set of performance parameters.
METHODS
Ten experienced ophthalmologists and six medical residents were invited to perform the virtual surgery of the four main phacoemulsification cataract surgery procedures - 1) corneal incision (CI), 2) capsulorhexis (C), 3) phacoemulsification (P), and 4) intraocular lens implantation (IOL). Each participant was required to perform the complete phacoemulsification cataract surgery using the simulator for three consecutive trials (a standardized 30-min session). The performance of the participants during the three trials was supported using a visual guidance system and evaluated by referring to a set of parameters that was implemented in the performance evaluation system of the simulator.
RESULTS
Subjects with greater experience obtained significantly higher scores in all four main procedures - CI1 (ρ = 0.038), CI2 (ρ = 0.041), C1 (ρ = 0.032), P2 (ρ = 0.035) and IOL1 (ρ = 0.011). It was also found that experience improved the completion times in all modules - CI4 (ρ = 0.026), C4 (ρ = 0.018), P6 (ρ = 0.028) and IOL4 (ρ = 0.029). Positive correlation was observed between experience and anti-tremor - C2 (ρ = 0.026), P3 (ρ = 0.015), P4 (ρ = 0.042) and IOL2 (ρ = 0.048) and similarly with anti-rupture - CI3 (ρ = 0.013), C3 (ρ = 0.027), P5 (ρ = 0.021) and IOL3 (ρ = 0.041). No significant difference was observed between the groups with regards to P1 (ρ = 0.077).
CONCLUSIONS
Statistical analysis of the results obtained from repetitive trials between two groups of users reveal that augmented virtual reality (VR) simulators have the potential and capability to be used as a feasible proficiency assessment tool for the complete four main procedures of phacoemulsification cataract surgery (ρ < 0.05), indicating the construct validity of the modules simulated with augmented visual guidance and assessed through performance parameters.
背景
基于计算机的外科手术培训被认为能够为医学专业人员提供一个可控的虚拟环境，以便他们在虚拟人体部位上进行标准化培训或新的实验程序，这些虚拟人体部位在数字显示单元上以三维方式生成并可视化。本研究的主要目的是在配备视觉引导系统和一组性能参数的虚拟现实平台上进行虚拟超声乳化白内障手术，以比较不同熟练程度用户的表现。
方法
邀请了10名经验丰富的眼科医生和6名住院医生进行四种主要的超声乳化白内障手术程序的虚拟手术——1）角膜切口（CI），2）连续环形撕囊（C），3）超声乳化（P），以及4）人工晶状体植入（IOL）。要求每位参与者使用模拟器连续进行三次完整的超声乳化白内障手术试验（一次标准化的30分钟课程）。在三次试验中，参与者的表现由视觉引导系统提供支持，并通过参考模拟器性能评估系统中实施的一组参数进行评估。
结果
经验更丰富的受试者在所有四个主要程序中获得的分数显著更高——CI1（ρ = 0.038）、CI2（ρ = 0.041）、C1（ρ = 0.032）、P2（ρ = 0.035）和IOL1（ρ = 0.011）。还发现经验缩短了所有模块的完成时间——CI4（ρ = 0.026）、C4（ρ = 0.018）、P6（ρ = 0.028）和IOL4（ρ = 0.029）。经验与抗震颤之间存在正相关——C2（ρ = 0.026）、P3（ρ = 0.015）、P4（ρ = 0.042）和IOL2（ρ = 0.048），与抗破裂情况类似——CI3（ρ = 0.013）、C3（ρ = 0.027）、P5（ρ = 0.021）和IOL3（ρ = 0.041）。两组在P1方面未观察到显著差异（ρ = 0.077）。
结论
对两组用户重复试验结果的统计分析表明，增强虚拟现实（VR）模拟器有潜力且有能力用作超声乳化白内障手术四个主要程序的可行熟练程度评估工具（ρ < 0.05），这表明通过增强视觉引导模拟并通过性能参数评估的模块具有结构效度。
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