Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study.

BACKGROUND: The advent of Virtual Reality technologies presents new opportunities for enhancing current surgical practice. Studies suggest that current techniques in endoscopic surgery are prone to disturbance of a surgeon's visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The Microsoft® HoloLens is a novel head-mounted display that has not been explored within surgical innovation research. This study aims to evaluate the HoloLens as a potential alternative to conventional monitors in endoscopic surgery. MATERIALS AND METHODS: This prospective, observational and comparative study recruited 72 participants consisting of novices (n = 28), intermediate-level (n = 24) and experts (n = 20). Participants performed ureteroscopy, within an inflatable operating environment, using a validated training model and the HoloLens mixed-reality device as a monitor. Novices also completed the assigned task using conventional monitors; whilst the experienced groups did not, due to their extensive familiarity. Outcome measures were procedural completion time and performance evaluation (OSATS) score. A final evaluation survey was distributed amongst all participants. RESULTS: The HoloLens facilitated improved outcomes for procedural times (absolute difference, - 73 s; 95% CI - 115 to - 30; P = 0.0011) and OSAT scores (absolute difference, 4.1 points; 95% CI 2.9-5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% CI 4.5-4.8). Furthermore, 95% of participants agreed or strongly agreed that the HoloLens is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% CI 4.2-4.5). CONCLUSION: This study demonstrates that the device facilitated improved outcomes of performance in novices and was widely accepted as a surgical visual aid by all groups. The HoloLens represents a feasible alternative to the conventional setup, possibly by aligning the surgeon's visual-motor axis.

Predictors of failure after initial arthroscopic washout in septic arthritis of native knee joint- a retrospective analysis.

BACKGROUND: Acute septic arthritis of the knee is an orthopaedic emergency requiring prompt debridement and washout to reduce infection. However, more than one washout procedure may be required to eradicate infection. This study was performed to analyse the factors associated with the failure of a single arthroscopic washout. METHODS: This is a retrospective analysis of 78 patients with septic arthritis of the knee over 6 years from January 2015 from a single trauma centre. We analysed the variables like patient demographic factors, comorbidities, laboratory parameters and various operative and non-operative factors with regard to the outcome after a single arthroscopic washout. Statistical analysis using univariate and multivariate logistic regression analysis were performed to identify the variables associated. RESULTS: Out of the 78 patients who underwent arthroscopic washout for a diagnosis of septic arthritis, 31 patients (39.74%) had failure of a single arthroscopic washout, with six patients (7.69%) requiring two additional washouts and one patient (1.28%) requiring three additional washouts to eradicate infection. Statistical analysis identified high temperature at presentation (p value 0.084), BMI >45 (p value 0.025), high CRP (0.014), high neutrophil count (p value 0.113) and high creatinine (p value 0.111) as the predictors of failure of a single arthroscopic washout. CONCLUSION: A high failure rate (39.74%) was seen with a single arthroscopic washout procedure. A high BMI, elevated CRP, higher temperature at presentation, elevated neutrophil count were identified as the predictors of failure of a single arthroscopic washout for septic arthritis of the knee in our study.

Evaluation of the Endo-Uro trainer for semi-rigid ureteroscopy training.

BACKGROUND: The aim of this study was to evaluate the validity of evidence of the Endo-Uro Trainer (SAMED, Dresden, Germany) for semi-rigid ureteroscopy. METHODS: Novice (n = 29), intermediate-level (n = 25), and expert (n = 24) urological surgeons were recruited to participate in the study. Novices were allocated randomly to Groups A and B, where A performed two set procedures using the already validated Uro-Scopic Trainer (Limbs and Things, Bristol, UK), and Group B used the Endo-Uro trainer. Subsequently they were crossed over to perform the same two procedures using the other model. Intermediate and expert groups performed the same procedure on the Endo-Uro trainer only. Objective Structured Assessment of Technical Skills (OSATS) and the procedural times were collected and analyzed. All participants were invited to complete a final evaluation survey. RESULTS: The evaluation survey revealed a realism rating in all aspects, with a mean Likert rating of 4.04/5. Significant differences were observed in performance time between novices and experts (p = 0.0014), and between intermediates and experts (p = 0.0113). OSATS scores differed significantly between all groups (p < 0.0001). Group B novices showed statistically significant improvement in performance time (p = 0.0012) and OSATS scores (p = 0.0439) after the crossover. Significant differences in performance time (p = 0.0025) between groups A and B were also observed post-crossover. CONCLUSIONS: This study demonstrated content validity for the Endo-Uro Trainer model. In addition, the model was shown to be capable of differentiating levels of experience, which contributes to the acceptance of the validity hypothesis. Improvement in performance using the model demonstrates its effectiveness for training.