Department of Orthopedics Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
Intelligent Medical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Int J Surg. 2024 Sep 1;110(9):5334-5341. doi: 10.1097/JS9.0000000000001662.
The demand for telesurgery is rapidly increasing. Augmented reality (AR) remote surgery is a promising alternative, fulfilling a worldwide need in fracture surgery. However, previous AR endoscopic and Google Glass remotes remain unsuitable for fracture surgery, and the application of remote fracture surgery has not been reported. The authors aimed to evaluate the safety and clinical effectiveness of a new AR remote in fracture surgery.
This retrospective non-inferiority cohort study was conducted at three centres. Between 1 January 2018 and 31 March 2022, 800 patients who underwent fracture surgery were eligible for participation. The study enroled 551 patients with fractures (132 patellae, 128 elbows, 126 tibial plateaus, and 165 ankles) divided into an AR group (specialists used AR to remotely guide junior doctors to perform surgeries) and a traditional non-remote group (specialists performed the surgery themselves).
Among 364 patients (182 per group) matched by propensity score, seven (3.8%) in the AR group and six (3%) in the non-remote group developed complications. The 0.005 risk difference (95% CI: -0.033 to 0.044) was below the pre-defined non-inferiority margin of a 10% absolute increase. A similar distribution in the individual components of all complications was found between the groups. Hierarchical analysis following propensity score matching revealed no statistical difference between the two groups regarding functional results at 1-year follow-up, operative time, amount of bleeding, number of fluoroscopies, and injury surgery interval. A Likert scale questionnaire showed positive results (median scores: 4-5) for safety, efficiency, and education.
This study is the first to report that AR remote surgery can be as safe and effective as that performed by a specialist in person for fracture surgery, even without the physical presence of a specialist, and is associated with improving the skills and increasing the confidence of junior surgeons. This technique is promising for remote fracture surgery and other open surgeries, offering a new strategy to address inadequate medical care in remote areas.
远程手术的需求正在迅速增长。增强现实（AR）远程手术是一种很有前途的替代方法，可以满足全球骨折手术的需求。然而，之前的 AR 内窥镜和 Google Glass 远程手术仍不适合骨折手术，并且远程骨折手术的应用尚未得到报道。作者旨在评估一种新的 AR 远程在骨折手术中的安全性和临床效果。
这是一项在三个中心进行的回顾性非劣效性队列研究。2018 年 1 月 1 日至 2022 年 3 月 31 日期间，800 名接受骨折手术的患者符合参与条件。该研究共纳入 551 例骨折患者（132 例髌骨、128 例肘部、126 例胫骨平台和 165 例踝关节），分为 AR 组（专家使用 AR 远程指导初级医生进行手术）和传统非远程组（专家亲自进行手术）。
在通过倾向评分匹配的 364 名患者（每组 182 名）中，AR 组有 7 名（3.8%）和非远程组有 6 名（3%）发生并发症。0.005 的风险差异（95%CI：-0.033 至 0.044）低于预先设定的 10%绝对增加的非劣效性边界。两组之间所有并发症的个别成分分布相似。在倾向评分匹配后进行的层次分析显示，两组在 1 年随访时的功能结果、手术时间、出血量、透视次数和损伤手术间隔方面无统计学差异。Likert 量表问卷调查显示，在安全性、效率和教育方面均得到了积极的结果（中位数评分：4-5）。
这是第一项报道 AR 远程手术可以与专家亲自进行的骨折手术一样安全有效的研究，即使专家不在场，也与提高初级外科医生的技能和信心有关。这项技术有望用于远程骨折手术和其他开放手术，为解决偏远地区医疗服务不足提供了一种新策略。
