Shoshany Talia N, Agranat Joshua S, Armstrong Grayson, Miller John B
Department of Ophthalmology, Harvard Medical School Boston, MA, USA.
Retina Service, Massachusetts Eye and Ear, Boston, MA, USA.
J Vitreoretin Dis. 2020 Jun 18;4(6):459-466. doi: 10.1177/2474126420929614. eCollection 2020 Nov-Dec.
This work assesses the educational use of a 3-dimensional (3D) heads-up visualization system for vitreoretinal surgery.
A cross-sectional survey was performed among 18 medical students, 18 residents, 7 VR fellows, 6 nurses, 4 anesthesiologists, and 3 surgeons on their experience with the Ngenuity 3D Visualization System (TrueVision and Alcon) compared with the standard microscope.
Most medical students (88%) reported better identification of surgical landmarks; 63% ranked the Ngenuity as their preferred method of learning (vs microscope or 2-dimensional display). Residents reported a superior understanding of anatomy (69%), an increased ability to ask questions (63%), and improved ergonomics (94%). Epiretinal membrane peel, internal limiting membrane peel, and core vitrectomy were most enhanced (69% to 77%) for residents. Fellows' experience with trocar placement, vitrectomy, and oil/gas insertion was the same as before (67% to 100%), whereas endolaser and closing were worse (67% to 100%). Regarding autonomy, 83% of fellows reported no change, whereas 17% reported increased levels. Nurses were better able to track case progress (67%) and anticipate which tools were needed (50%). All anesthesiologists reported the same or worse engagement in cases, noting it was difficult to switch between the 3D screen and the anesthesia equipment. All surgeons reported a better awareness of trainees in the room and an improved ability to point out landmarks; 67% reported being more comfortable with resident and fellow autonomy.
The Ngenuity is most helpful to students and residents. Integrating 3D displays into the surgical curriculum is beneficial, with care to ensure nurse and anesthesiologist satisfaction.
本研究评估三维（3D）平视可视化系统在玻璃体视网膜手术中的教育应用。
对18名医学生、18名住院医师、7名玻璃体视网膜专科进修医生、6名护士、4名麻醉医生和3名外科医生进行横断面调查，比较他们使用Ngenuity 3D可视化系统（TrueVision和爱尔康公司）与标准显微镜的体验。
大多数医学生（88%）报告称能更好地识别手术标志；63%将Ngenuity列为他们首选的学习方法（与显微镜或二维显示器相比）。住院医师报告称对解剖结构的理解更优（69%）、提问能力增强（63%）以及人体工程学改善（94%）。住院医师进行视网膜前膜剥离、内界膜剥离和核心玻璃体切割时的体验改善最为明显（69%至77%）。进修医生进行套管针置入、玻璃体切割和硅油/气体注入的体验与之前相同（67%至100%），而内激光治疗和手术结束环节的体验变差（67%至100%）。在自主性方面，83%的进修医生报告无变化，而17%报告自主性增强。护士能更好地跟踪病例进展（67%）并预测所需工具（50%）。所有麻醉医生报告在病例中的参与度相同或更低，指出在3D屏幕和麻醉设备之间切换困难。所有外科医生报告对手术室中学员的关注度更高，指出手术标志的能力增强；67%报告对住院医师和进修医生的自主性更放心。
Ngenuity对学生和住院医师最有帮助。将3D显示器整合到手术课程中是有益的，但要注意确保护士和麻醉医生的满意度。
