A remote access mixed reality teaching ward round.

BACKGROUND: Heterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID-19 pandemic, with limited exposure to patients for clinical teaching. METHODS: We conducted a proof-of-concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round. RESULTS: Students unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education. DISCUSSION: We have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high-quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.

Perfect Registration Leads to Imperfect Performance: A Randomized Trial of Multimodal Intraoperative Image Guidance.

OBJECTIVE: To compare surgical safety and efficiency of 2 image guidance modalities, perfect augmented reality (AR) and side-by-side unregistered image guidance (IG), against a no guidance control (NG), when performing a simulated laparoscopic cholecystectomy (LC). BACKGROUND: Image guidance using AR offers the potential to improve understanding of subsurface anatomy, with positive ramifications for surgical safety and efficiency. No intra-abdominal study has demonstrated any advantage for the technology. Perfect AR cannot be provided in the operative setting in a patient; however, it can be generated in the simulated setting. METHODS: Thirty-six experienced surgeons performed a baseline LC using the LapMentor simulator before randomization to 1 of 3 study arms: AR, IG, or NG. Each performed 3 further LC. Safety and efficiency-related simulator metrics, and task workload (SURG-TLX) were collected. RESULTS: The IG group had a shorter total instrument path length and fewer movements than NG and AR groups. Both IG and NG took a significantly shorter time than AR to complete dissection of Calot triangle. Use of IG and AR resulted in significantly fewer perforations and serious complications than the NG group. IG had significantly fewer perforations and serious complications than the AR group. Compared with IG, AR guidance was found to be significantly more distracting. CONCLUSION: Side-by-side unregistered image guidance (IG) improved safety and surgical efficiency in a simulated setting when compared with AR or NG. IG provides a more tangible opportunity for integrating image guidance into existing surgical workflow as well as delivering the safety and efficiency benefits desired.

Evaluating a Novel 3D Stereoscopic Visual Display for Transanal Endoscopic Surgery: A Randomized Controlled Crossover Study.

OBJECTIVE: To compare surgical performance with transanal endoscopic surgery (TES) using a novel 3-dimensional (3D) stereoscopic viewer against the current modalities of a 3D stereoendoscope, 3D, and 2-dimensional (2D) high-definition monitors. BACKGROUND: TES is accepted as the primary treatment for selected rectal tumors. Current TES systems offer a 2D monitor, or 3D image, viewed directly via a stereoendoscope, necessitating an uncomfortable operating position. To address this and provide a platform for future image augmentation, a 3D stereoscopic display was created. METHODS: Forty participants, of mixed experience level, completed a simulated TES task using 4 visual displays (novel stereoscopic viewer and currently utilized stereoendoscope, 3D, and 2D high-definition monitors) in a randomly allocated order. Primary outcome measures were: time taken, path length, and accuracy. Secondary outcomes were: task workload and participant questionnaire results. RESULTS: Median time taken and path length were significantly shorter for the novel viewer versus 2D and 3D, and not significantly different to the traditional stereoendoscope. Significant differences were found in accuracy, task workload, and questionnaire assessment in favor of the novel viewer, as compared to all 3 modalities. CONCLUSIONS: This novel 3D stereoscopic viewer allows surgical performance in TES equivalent to that achieved using the current stereoendoscope and superior to standard 2D and 3D displays, but with lower physical and mental demands for the surgeon. Participants expressed a preference for this system, ranking it more highly on a questionnaire. Clinical translation of this work has begun with the novel viewer being used in 5 TES patients.

Quantifying innovation in surgery.

OBJECTIVES: The objectives of this study were to assess the applicability of patents and publications as metrics of surgical technology and innovation; evaluate the historical relationship between patents and publications; develop a methodology that can be used to determine the rate of innovation growth in any given health care technology. BACKGROUND: The study of health care innovation represents an emerging academic field, yet it is limited by a lack of valid scientific methods for quantitative analysis. This article explores and cross-validates 2 innovation metrics using surgical technology as an exemplar. METHODS: Electronic patenting databases and the MEDLINE database were searched between 1980 and 2010 for "surgeon" OR "surgical" OR "surgery." Resulting patent codes were grouped into technology clusters. Growth curves were plotted for these technology clusters to establish the rate and characteristics of growth. RESULTS: The initial search retrieved 52,046 patents and 1,801,075 publications. The top performing technology cluster of the last 30 years was minimally invasive surgery. Robotic surgery, surgical staplers, and image guidance were the most emergent technology clusters. When examining the growth curves for these clusters they were found to follow an S-shaped pattern of growth, with the emergent technologies lying on the exponential phases of their respective growth curves. In addition, publication and patent counts were closely correlated in areas of technology expansion. CONCLUSIONS: This article demonstrates the utility of publically available patent and publication data to quantify innovations within surgical technology and proposes a novel methodology for assessing and forecasting areas of technological innovation.

Augmented reality partial nephrectomy: examining the current status and future perspectives.

A minimal access approach to partial nephrectomy has historically been under-utilized, but is now becoming more popular with the growth of robot-assisted laparoscopy. One of the criticisms of minimal access partial nephrectomy is the loss of haptic feedback. Augmented reality operating environments are forecast to play a major enabling role in the future of minimal access partial nephrectomy by integrating enhanced visual information to supplement this loss of haptic sensation. In this article, we systematically examine the current status of augmented reality in partial nephrectomy by identifying existing research challenges and exploring future agendas for this technology to achieve wider clinical translation.

Image-guided robotic interventions for prostate cancer.

Robotic prostatectomy is a common surgical treatment for men with prostate cancer, with some studies estimating that 80% of prostatectomies now performed in the USA are done so robotically. Despite the technical advantages offered by robotic systems, functional and oncological outcomes of prostatectomy can still be improved further. Alternative minimally invasive treatments that have also adopted robotic platforms include brachytherapy and high-intensity focused ultrasonography (HIFU). These techniques require real-time image guidance--such as ultrasonography or MRI--to be truly effective; issues with software compatibility as well as image registration and tracking currently limit such technologies. However, image-guided robotics is a fast-growing area of research that combines the improved ergonomics of robotic systems with the improved visualization of modern imaging modalities. Although the benefits of a real-time image-guided robotic system to improve the precision of surgical interventions are being realized, the clinical usefulness of many of these systems remains to be seen.