Layard Horsfall Hugo, Mao Zeqian, Koh Chan Hee, Khan Danyal Z, Muirhead William, Stoyanov Danail, Marcus Hani J
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom.
Front Surg. 2022 Jun 6;9:920252. doi: 10.3389/fsurg.2022.920252. eCollection 2022.
An exoscope heralds a new era of optics in surgery. However, there is limited quantitative evidence describing and comparing the learning curve.
This study aimed to investigate the learning curve, plateau, and rate of novice surgeons using an Olympus ORBEYE exoscope compared to an operating microscope (Carl Zeiss OPMI PENTERO or KINEVO 900).
A preclinical, randomized, crossover, noninferiority trial assessed the performance of seventeen novice and seven expert surgeons completing the microsurgical grape dissection task "Star's the limit." A standardized star was drawn on a grape using a stencil with a 5 mm edge length. Participants cut the star and peeled the star-shaped skin off the grape with microscissors and forceps while minimizing damage to the grape flesh. Participants repeated the task 20 times consecutively for each optical device. Learning was assessed using model functions such as the Weibull function, and the cognitive workload was assessed with the NASA Task Load Index (NASA-TLX).
Seventeen novice (male:female 12:5; median years of training 0.4 [0-2.8 years]) and six expert (male:female 4:2; median years of training 10 [8.9-24 years]) surgeons were recruited. "Star's the limit" was validated using a performance score that gave a threshold of expert performance of 70 (0-100). The learning rate (ORBEYE -0.94 ± 0.37; microscope -1.30 ± 0.46) and learning plateau (ORBEYE 64.89 ± 8.81; microscope 65.93 ± 9.44) of the ORBEYE were significantly noninferior compared to those of the microscope group ( = 0.009; = 0.027, respectively). The cognitive workload on NASA-TLX was higher for the ORBEYE. Novices preferred the freedom of movement and ergonomics of the ORBEYE but preferred the visualization of the microscope.
This is the first study to quantify the ORBEYE learning curve and the first randomized controlled trial to compare the ORBEYE learning curve to that of the microscope. The plateau performance and learning rate of the ORBEYE are significantly noninferior to those of the microscope in a preclinical grape dissection task. This study also supports the ergonomics of the ORBEYE as reported in preliminary observational studies and highlights visualization as a focus for further development.
外视镜开创了手术光学的新时代。然而，描述和比较学习曲线的定量证据有限。
本研究旨在调查与手术显微镜（卡尔蔡司OPMI PENTERO或KINEVO 900）相比，新手外科医生使用奥林巴斯ORBEYE外视镜的学习曲线、平台期和学习速度。
一项临床前、随机、交叉、非劣效性试验评估了17名新手外科医生和7名专家外科医生完成显微手术葡萄解剖任务“极限之星”的表现。使用边长为5毫米的模板在葡萄上绘制一个标准化的星星。参与者用显微剪刀和镊子剪下星星并将星星形状的葡萄皮从葡萄上剥下，同时尽量减少对葡萄果肉的损伤。参与者对每种光学设备连续重复该任务20次。使用威布尔函数等模型函数评估学习情况，并用美国国家航空航天局任务负荷指数（NASA-TLX）评估认知工作量。
招募了17名新手（男：女12：5；中位培训年限0.4[0 - 2.8年]）和6名专家（男：女4：2；中位培训年限10[8.9 - 24年]）外科医生。使用性能评分对“极限之星”进行验证，该评分给出专家表现的阈值为70（0 - 100）。与显微镜组相比，ORBEYE的学习速度（ORBEYE -0.94±0.37；显微镜 -1.30±0.46）和学习平台期（ORBEYE 64.89±8.81；显微镜65.93±9.44）明显非劣效（分别为P = 0.009；P = 0.027）。ORBEYE在NASA-TLX上的认知工作量更高。新手更喜欢ORBEYE的活动自由度和人体工程学设计，但更喜欢显微镜的可视化效果。
这是第一项量化ORBEYE学习曲线的研究，也是第一项将ORBEYE学习曲线与显微镜学习曲线进行比较的随机对照试验。在临床前葡萄解剖任务中，ORBEYE的平台期表现和学习速度明显不劣于显微镜。本研究还支持了初步观察研究中报道的ORBEYE的人体工程学设计，并强调可视化是进一步发展的重点。
