MRC Centre for Transplantation, Guy's Hospital, King's College London, 5th Floor Southwark Wing, London, SE1 9RT, UK.
ASST Santi Paolo e Carlo, Università degli Studi di Milano, Milan, Italy.
Surg Endosc. 2020 Mar;34(3):1143-1149. doi: 10.1007/s00464-019-06862-3. Epub 2019 Jun 18.
BACKGROUND: The advent of Virtual Reality technologies presents new opportunities for enhancing current surgical practice. Studies suggest that current techniques in endoscopic surgery are prone to disturbance of a surgeon's visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The Microsoft HoloLens is a novel head-mounted display that has not been explored within surgical innovation research. This study aims to evaluate the HoloLens as a potential alternative to conventional monitors in endoscopic surgery. MATERIALS AND METHODS: This prospective, observational and comparative study recruited 72 participants consisting of novices (n = 28), intermediate-level (n = 24) and experts (n = 20). Participants performed ureteroscopy, within an inflatable operating environment, using a validated training model and the HoloLens mixed-reality device as a monitor. Novices also completed the assigned task using conventional monitors; whilst the experienced groups did not, due to their extensive familiarity. Outcome measures were procedural completion time and performance evaluation (OSATS) score. A final evaluation survey was distributed amongst all participants. RESULTS: The HoloLens facilitated improved outcomes for procedural times (absolute difference, - 73 s; 95% CI - 115 to - 30; P = 0.0011) and OSAT scores (absolute difference, 4.1 points; 95% CI 2.9-5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% CI 4.5-4.8). Furthermore, 95% of participants agreed or strongly agreed that the HoloLens is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% CI 4.2-4.5). CONCLUSION: This study demonstrates that the device facilitated improved outcomes of performance in novices and was widely accepted as a surgical visual aid by all groups. The HoloLens represents a feasible alternative to the conventional setup, possibly by aligning the surgeon's visual-motor axis.
背景：虚拟现实技术的出现为增强当前的外科手术实践提供了新的机会。研究表明，目前的内窥镜手术技术容易干扰外科医生的视觉-运动轴，从而影响手术表现、人体工程学和医源性损伤率。微软 HoloLens 是一种新颖的头戴式显示器，尚未在内窥镜手术创新研究中进行探索。本研究旨在评估 HoloLens 作为内窥镜手术中替代传统显示器的潜在选择。
材料和方法：这是一项前瞻性、观察性和比较性研究，共招募了 72 名参与者，包括新手（n=28）、中级（n=24）和专家（n=20）。参与者在内窥镜手术中使用验证过的培训模型和 HoloLens 混合现实设备作为显示器，在可充气手术环境中进行输尿管镜检查。新手还使用传统显示器完成了指定任务；而经验丰富的组则没有，因为他们非常熟悉。评估指标为手术完成时间和手术表现评估（OSATS）评分。所有参与者均完成了最终评估问卷调查。
结果：与传统显示器相比，HoloLens 为手术时间（绝对差值，-73 秒；95%置信区间 -115 至 -30；P=0.0011）和 OSAT 评分（绝对差值，4.1 分；95%置信区间 2.9-5.3；P<0.0001）带来了更好的结果。反馈评估显示，97%的参与者同意或强烈同意 HoloLens 将在外科教育中发挥作用（平均评分，4.6 分（满分 5 分）；95%置信区间 4.5-4.8）。此外，95%的参与者同意或强烈同意 HoloLens 在临床上具有可行性，并且将在手术中发挥作用（平均评分，4.4 分（满分 5 分）；95%置信区间 4.2-4.5）。
结论：本研究表明，该设备提高了新手的手术表现，并得到了所有组别作为外科手术视觉辅助工具的广泛认可。HoloLens 可能通过对准外科医生的视觉-运动轴，代表了替代传统设置的一种可行选择。
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