虚拟现实热身在机器人辅助手术前的随机对照试验。
Virtual Reality Warm-up Before Robot-assisted Surgery: A Randomized Controlled Trial.
机构信息
University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota.
University of Minnesota, Department of Mechanical Engineering, Minneapolis, Minnesota.
出版信息
J Surg Res. 2021 Aug;264:107-116. doi: 10.1016/j.jss.2021.01.037. Epub 2021 Mar 31.
TRIAL DESIGN
This was a randomized controlled trial.
BACKGROUND
Intraoperative errors correlate with surgeon skill and skill declines with intervals of inactivity. The goals of this research were to identify the optimal virtual reality (VR) warm-up curriculum to prime a surgeon's technical skill and validate benefit in the operating room.
MATERIALS AND METHODS
Surgeons were randomized to receive six trial sessions of a designated set of VR modules on the da Vinci Skills Simulator to identify optimal VR warm-up curricula to prime technical skill. After performing their curricula, warm-up effect was assessed based on performance on a criterion task. The optimal warm-up curriculum was chosen from the group with the best task time and video review-based technical skill. Robot-assisted surgery-experienced surgeons were then recruited to either receive or not receive warm-up before surgery. Skill in the first 15 min of surgery was assessed by blinded surgeon and crowdworker review as well as tool motion metrics. The intervention was performing VR warm-up before human robot-assisted surgery. Warm-up effect was measured using objective performance metrics and video review using the Global Evaluative Assessment of Robotic Skills tool. Linear mixed effects models with a random intercept for each surgeon and nonparametric modified Friedman tests were used for analysis.
RESULTS
The group performing only a Running Suture task on the simulator was on average 31.3 s faster than groups performing other simulation tasks and had the highest Global Evaluative Assessment of Robotic Skills scores from 41 surgeons who participated. This was chosen as the optimal curriculum. Thereafter, 34 surgeons completed 347 surgeries with corresponding video and tool motion data. No statistically significant differences in skill were observed with the warm-up intervention.
CONCLUSIONS
We conclude that a robotic VR warm-up before performing the early stages of surgery does not impact the technical skill of the surgeon.
试验设计
这是一项随机对照试验。
背景
术中错误与外科医生的技能相关，并且技能会随着不活动的时间间隔而下降。本研究的目的是确定最佳的虚拟现实（VR）热身课程，以激发外科医生的技术技能，并在手术室中验证其益处。
材料和方法
外科医生被随机分配接受六次指定的达芬奇技能模拟器 VR 模块试验，以确定最佳的 VR 热身课程，以激发技术技能。在完成课程后，根据基准任务的表现评估热身效果。从组间最佳任务时间和基于视频审查的技术技能中选择最佳热身课程。然后招募有机器人辅助手术经验的外科医生，让他们在手术前接受或不接受热身。通过盲法外科医生和众包审查以及工具运动指标评估手术前 15 分钟的技能。干预措施是在进行人机机器人辅助手术之前进行 VR 热身。使用客观绩效指标和使用全球评估机器人技能工具的视频审查来衡量热身效果。使用具有每个外科医生随机截距的线性混合效应模型和非参数修正 Friedman 检验进行分析。
结果
仅在模拟器上执行跑步缝合任务的组平均比执行其他模拟任务的组快 31.3 秒，并且来自 41 名参与的外科医生的全球评估机器人技能得分最高。这被选为最佳课程。此后，34 名外科医生完成了 347 例手术，并附有相应的视频和工具运动数据。热身干预对技能没有统计学上的显著影响。
结论
我们得出结论，在进行手术早期阶段之前进行机器人 VR 热身不会影响外科医生的技术技能。
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