Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong.
The University of Hong Kong, Hong Kong.
Surg Innov. 2023 Aug;30(4):477-485. doi: 10.1177/15533506221142960. Epub 2022 Nov 30.
Our prototype wireless full-HD Augmented Reality Head-Mounted Display (AR-HMD) aims to eliminate surgeon head turning and reduce theater clutter. Learning and performance versus TV Monitors (TVM) is evaluated in simulated knee arthroscopy.
19 surgeons and 19 novices were randomized into either the control group (A) or intervention group (B) and tasked to perform 5 simulated loose-body retrieval procedures on a bench-top knee arthroscopy simulator. A cross-over study design was adopted whereby subjects alternated between devices during trials 1-3, deemed the "Unfamiliar" phase, and then used the same device consecutively in trials 4-5, to assess performance in a more "Familiarized" state. Measured outcomes were time-to-completion and incidence of bead drops.
In the unfamiliar phase, HMD had 67% longer mean time-to-completion than TVM (194.7 ± 152.6s vs 116.7 ± 78.7s, < .001). Once familiarized, HMD remained inferior to TVM, with 48% longer completion times (133.8 ± 123.3s vs 90.6 ± 55s, = .052). Cox regression revealed device type (OR = 0.526, CI 0.391-0.709, < .001) and number of procedure repetitions (OR = 1.186, CI 1.072-1.311, = .001) are significantly and independently related to faster time-to-completion. However, experience is not a significant factor (OR = 1.301, CI 0.971-1.741, = .078). Bead drops were similar between the groups in both unfamiliar (HMD: 27 vs TVM: 22, = .65) and familiarized phases (HMD: 11 vs TVM: 17, = .97).
Arthroscopic procedures continue to be better performed under conventional TVM. However, similar quality levels can be reached by HMD when given more time. Given the theoretical advantages, further research into improving HMD designs is advocated.
我们的原型无线全高清增强现实头戴式显示器（AR-HMD）旨在消除外科医生转头和减少手术室杂乱。在模拟膝关节镜检查中评估学习和性能与电视监视器（TVM）相比。
19 名外科医生和 19 名新手随机分为对照组（A）或干预组（B），并在台式膝关节镜模拟器上执行 5 项模拟游离体检索程序。采用交叉研究设计，在第 1-3 次试验中，受试者在“不熟悉”阶段交替使用设备，然后在第 4-5 次试验中连续使用同一设备，以评估在更“熟悉”状态下的表现。测量结果是完成时间和珠子掉落的发生率。
在不熟悉阶段，HMD 的平均完成时间比 TVM 长 67%（194.7 ± 152.6s 比 116.7 ± 78.7s， <.001）。一旦熟悉，HMD 仍然不如 TVM，完成时间长 48%（133.8 ± 123.3s 比 90.6 ± 55s， =.052）。Cox 回归显示设备类型（OR = 0.526，CI 0.391-0.709， <.001）和程序重复次数（OR = 1.186，CI 1.072-1.311， =.001）与更快的完成时间显著相关。然而，经验不是一个显著因素（OR = 1.301，CI 0.971-1.741， =.078）。在不熟悉阶段（HMD：27 比 TVM：22， =.65）和熟悉阶段（HMD：11 比 TVM：17， =.97），珠子掉落两组相似。
在传统 TVM 下，关节镜手术仍能更好地进行。然而，当给予更多时间时，HMD 可以达到相似的质量水平。鉴于理论优势，提倡进一步研究改进 HMD 设计。
