Augmented reality self-training system for suturing in open surgery: A randomized controlled trial.

BACKGROUND: Existing self-training materials are insufficient to learn open surgical procedures, and a new self-training system that provides three-dimensional procedural information is needed. The effectiveness and usability of a self-training system providing three-dimensional information by augmented reality (AR) were compared to those of an existing self-training system, instructional video, in self-learning of suturing in open surgery. MATERIALS AND METHODS: This was a prospective, evaluator-blinded, randomized, controlled study. Medical students who were suturing novices were randomized into 2 groups: practice with the AR training system (AR group) or an instructional video (video group). Participants were instructed in subcuticular interrupted suture and each training system and watched the instructional video once. They then completed a pretest performing the suture on a skin pad. Participants in each group practiced the procedure 10 times using each training system, followed by a posttest. The pretest and posttest were video-recorded and graded by blinded evaluators using a validated scoring form composed of global rating (GR) and task-specific (TS) subscales. Students completed a post-study questionnaire assessing system usability, each system's usefulness, and their confidence and interest in surgery. RESULTS: Nineteen participants in each group completed the trial. No significant difference was found between the AR and video groups on the improvement of the scores from pretest to posttest (GR: p = 0.54, TS: p = 0.91). The posttest scores of both GR and TS improved significantly from pretest in both groups (GR: both p < 0.001, TS: both p < 0.001). There was no significant difference between the groups in the system usability scale scores (p = 0.38). The motion provided in the AR system was more helpful for manipulating surgical instruments than the video (p = 0.02). CONCLUSION: The AR system was considered as understandable and easy to use as the instructional video in learning suture technique in open surgery for novices.

A Novel Suture Training System for Open Surgery Replicating Procedures Performed by Experts Using Augmented Reality.

The surgical education environment has been changing significantly due to restricted work hours, limited resources, and increasing public concern for safety and quality, leading to the evolution of simulation-based training in surgery. Of the various simulators, low-fidelity simulators are widely used to practice surgical skills such as sutures because they are portable, inexpensive, and easy to use without requiring complicated settings. However, since low-fidelity simulators do not offer any teaching information, trainees do self-practice with them, referring to textbooks or videos, which are insufficient to learn open surgical procedures. This study aimed to develop a new suture training system for open surgery that provides trainees with the three-dimensional information of exemplary procedures performed by experts and allows them to observe and imitate the procedures during self-practice. The proposed system consists of a motion capture system of surgical instruments and a three-dimensional replication system of captured procedures on the surgical field. Motion capture of surgical instruments was achieved inexpensively by using cylindrical augmented reality (AR) markers, and replication of captured procedures was realized by visualizing them three-dimensionally at the same position and orientation as captured, using an AR device. For subcuticular interrupted suture, it was confirmed that the proposed system enabled users to observe experts' procedures from any angle and imitate them by manipulating the actual surgical instruments during self-practice. We expect that this training system will contribute to developing a novel surgical training method that enables trainees to learn surgical skills by themselves in the absence of experts.

Companion Diagnosis for Retinal Neuroprotective Treatment by Real-Time Imaging of Calpain Activation Using a Novel Fluorescent Probe.

Calpain activation induces retinal ganglion cell (RGC) death, while calpain inhibition suppresses RGC death, in animal studies. However, the role of calpain in human retinal disease is unclear. This study investigated a new strategy to study the role of calpain based on real-time imaging. We synthesized a novel fluorescent probe for calpain, acetyl-l-leucyl-l-methionine-hydroxymethyl rhodamine green (Ac-LM-HMRG) and used it for real-time imaging of calpain activation. The toxicity of Ac-LM-HMRG was evaluated with a lactate dehydrogenase cytotoxicity assay, retinal sections, and electroretinograms. Here, we performed real-time imaging of calpain activation in a rat model. First, we administered N-methyl-d-aspartate (NMDA) to induce retinal injury. Twenty minutes later, we administered an intravitreal injection of Ac-LM-HMRG. Real-time imaging was then completed with a noninvasive confocal scanning laser ophthalmoscope. The inhibitory effect of SNJ-1945 against calpain activation was also examined with the same real-time imaging method. Ac-LM-HMRG had no toxic effects. The number of Ac-LM-HMRG-positive cells in real-time imaging significantly increased after NMDA injury, and SNJ-1945 significantly lowered the number of Ac-LM-HMRG-positive cells. Real-time imaging with Ac-LM-HMRG was able to quickly quantify the NMDA-induced activation of calpain and the inhibitory effect of SNJ-1945. This technique, used as a companion diagnostic system, may aid research into the development of new neuroprotective therapies.