Bing Eric G, Parham Groesbeck P, Cuevas Anthony, Fisher Boris, Skinner Jonathan, Mwanahamuntu Mulindi, Sullivan Richard
Southern Methodist University, Dallas, TX.
University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Glob Oncol. 2019 May;5:1-7. doi: 10.1200/JGO.18.00263.
Worldwide, more than 80% of people diagnosed with cancer will require surgery during their disease course, but only 5% to 20% of low- and middle-income countries have access to safe, affordable, and timely surgery. Developing surgical oncology skills requires significant time and mentoring. Virtual reality (VR) simulators can reduce the time required to master surgical procedures but are prohibitively expensive. We sought to determine whether a VR simulator using low-cost computer gaming equipment could train novice surgeons in Africa to perform a virtual radical abdominal (open) hysterectomy (RAH).
Our RAH VR simulator used the Oculus Rift (Oculus VR, Menlo Park, CA), a VR headset with hand controllers that costs less than $1,500. Surgical novices learned to perform five key steps of a virtual RAH. We measured and identified predictors of movement and time efficiency for the simulation.
Ten novice surgeons in Lusaka, Zambia, enrolled in the study. Movement and time efficiency greatly improved over time. Independent predictors of movement efficiency were number of simulations, surgical experience, and time since college graduation. Independent predictors of time efficiency were number of simulations, surgical experience, days between simulation sessions, age, sex, and an interaction between number of simulations and surgical experience.
Low-cost VR may be an effective tool to help surgical novices learn complex surgical oncology procedures. If learning to perform VR surgical procedures with low-cost hardware leads to faster mastery of surgical procedures in the operating room, low-cost VR may represent one of the solutions to increasing access to surgical cancer care globally.
在全球范围内，超过80%被诊断为癌症的患者在其病程中需要接受手术，但只有5%至20%的低收入和中等收入国家能够获得安全、可负担且及时的手术服务。培养外科肿瘤学技能需要大量时间和指导。虚拟现实（VR）模拟器可以减少掌握手术操作所需的时间，但价格昂贵得令人望而却步。我们试图确定使用低成本电脑游戏设备的VR模拟器能否培训非洲的新手外科医生进行虚拟根治性腹部（开放式）子宫切除术（RAH）。
我们的RAH VR模拟器使用了Oculus Rift（Oculus VR，加利福尼亚州门洛帕克），这是一款头戴式VR设备，配有手柄，成本低于1500美元。外科新手学习进行虚拟RAH的五个关键步骤。我们测量并确定了模拟中动作和时间效率的预测因素。
赞比亚卢萨卡的10名新手外科医生参与了该研究。随着时间的推移，动作和时间效率有了很大提高。动作效率的独立预测因素是模拟次数、手术经验以及大学毕业以来的时间。时间效率的独立预测因素是模拟次数、手术经验、模拟 sessions 之间的天数、年龄、性别以及模拟次数与手术经验之间的相互作用。
低成本VR可能是帮助外科新手学习复杂外科肿瘤学手术的有效工具。如果使用低成本硬件学习进行VR手术操作能导致在手术室更快掌握手术操作，那么低成本VR可能是增加全球癌症手术治疗可及性的解决方案之一。
