Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Institute of Simulation and Graphics, Faculty of Informatics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
JMIR Res Protoc. 2024 Nov 5;13:e59014. doi: 10.2196/59014.
Working in an operating room (OR) is physically and mentally challenging: the operation itself demands the surgeon's full attention, while time and cost efficiency constraints, daily planning, and emergency care interfere with the procedure. Thus, multitasking becomes an integral surgical competence. This study aims to examine the effect of disruptions during surgery in a highly immersive virtual reality (IVR) operation environment combined with a virtual reality (VR) laparoscopy simulator.
This study aims to identify distractions in the OR and their importance in the clinical setting.
An IVR environment was created using a high-resolution, stereoscopic 360° video of the OR. Different distractions were identified, classified as auditory, visual, or audio-visual, and recorded accordingly. The surrounding was combined with a VR laparoscopic simulator. Participants-medical students and surgical residents-received proficiency-based training in basic laparoscopic skills and were blinded to the aim of the experiment. Following a cross-over design, each participant received a unique order of virtual distraction factors while performing tasks on the laparoscopic simulator. During the experiment, subjective passing of time, stress, heart rate, and visually induced motion sickness are recorded. After the experiment, validated questionnaires for usability, immersion, and stress were completed, as well as subjective evaluation of the distractions. The questionnaires used included the system usability scale, Self-Assessment Manikin score, National Aeronautics and Space Administration Task Load Index, and the immersion rating scale as described by Nichols. Performance in the laparoscopic tasks in relation to distractions will be evaluated by the Wilcoxon test and ANOVA for continuous variables. Subgroup analyses in regard to age, gender, and expertise (medical students vs surgical residents) are planned.
The described trial started in August 2022 and is ongoing. By July 2024, a total of 30 medical students and 9 surgeons have completed the study.
We present a study protocol aiming to identify the impact of different disruptions in OR during laparoscopic training in IVR. Hence, it may lead to an improved awareness of distractions and facilitate accommodations toward an improved work environment. Prior research leads to the hypothesis that the performance of a more experienced surgeon is less impacted by distractions than the performance of inexperienced surgeons and medical students. Furthermore, we investigate which type of distraction has the largest impact on performance. With this knowledge, specific multitasking training can be devised, which may be particularly useful in medical education, for which VR might play a leading role. Additionally, workplace surroundings in the OR can be optimized with this knowledge.
German Registry for Clinical Trials DRKS00030033; https://drks.de/search/en/trial/DRKS00030033.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/59014.
在手术室（OR）工作身心俱疲：手术本身要求外科医生全神贯注，而时间和成本效率的限制、日常计划和紧急护理会干扰手术过程。因此，多项任务成为外科医生的一项基本技能。本研究旨在探讨在高度沉浸式虚拟现实（IVR）手术环境中结合虚拟现实（VR）腹腔镜模拟器进行手术时，手术中断的影响。
本研究旨在确定手术室中的干扰因素及其在临床环境中的重要性。
使用 OR 的高分辨率、立体 360°视频创建 IVR 环境。识别出不同的干扰因素，将其分类为听觉、视觉或视听，并进行相应记录。将周围环境与 VR 腹腔镜模拟器相结合。参与者-医学生和外科住院医师-接受了基本腹腔镜技能的基于能力的培训，并对实验目的一无所知。采用交叉设计，每个参与者在腹腔镜模拟器上执行任务时都会收到一组独特的虚拟干扰因素。在实验过程中，记录主观时间流逝、压力、心率和视觉诱导的运动病。实验后，完成可用性、沉浸感和压力的验证问卷，以及对干扰因素的主观评价。使用的问卷包括系统可用性量表、自我评估量表、美国国家航空航天局任务负荷指数和 Nichols 描述的沉浸感评分量表。将使用 Wilcoxon 检验和 ANOVA 对与干扰相关的腹腔镜任务表现进行评估。计划按年龄、性别和专业知识（医学生与外科住院医师）进行亚组分析。
描述性试验于 2022 年 8 月开始，目前仍在进行中。到 2024 年 7 月，共有 30 名医学生和 9 名外科医生完成了研究。
我们提出了一项研究方案，旨在确定在 IVR 中进行腹腔镜训练时 OR 中不同干扰对手术的影响。因此，它可能会提高对干扰的认识，并有助于改善工作环境。先前的研究导致了这样的假设，即经验丰富的外科医生的表现受干扰的影响小于无经验的外科医生和医学生的表现。此外，我们还研究了哪种类型的干扰对表现的影响最大。有了这些知识，就可以设计出特定的多任务训练，这在医学教育中可能特别有用，而 VR 可能会在其中发挥主导作用。此外，还可以利用这些知识优化手术室的工作环境。
德国临床试验注册处 DRKS00030033；https://drks.de/search/en/trial/DRKS00030033。
国际注册报告标识符（IRRID）：DERR1-10.2196/59014。
