[Evidence, Availability and Future Visions in Simulation in General and Visceral Surgery]. / Evidenz, Verfügbarkeit und Zukunftsvisionen der Simulation in der Allgemein- und Viszeralchirurgie.

Practice makes perfect - a saying that everyone has certainly heard. Surgeons of all levels of training can demonstrably practice to some extent on simulators. This training outside the operating theatre and independent of patients makes sense, both ethically and financially. Although the effectiveness of simulation in surgery has been proven several times, simulation training is not a mandatory part of surgical specialist training in Germany. Simulation covers a very wide range in terms of application, effort and costs. This review is intended to give an overview of the systems and their areas of application and the target group. The focus lies on the commonly available systems and possible advantages and disadvantages. Practical skills are in the foreground and all three pillars of general and visceral surgery - conventional techniques, laparoscopy and robotics - are taken into account. However, simulators alone do not achieve cost-benefit effectiveness. The full potential of such an investment can only be exploited with a site-specific, structured training concept in which simulation training according to the post-graduate year and appropriate allocation to surgeries in the operating room are closely interlinked. It should always be possible to train basic skills on site. The significant additional costs for complex simulation systems are possible, depending on the financial resources, or should be purchased in a network or for national courses. The techniques of immersive virtual reality in combination with artificial intelligence and deformation algorithms will certainly play a decisive role for the future of simulation, whereby the use of the available systems must be a primary goal. The integration of simulation into specialist training should be striven for, not least in order to justify the costs.

Real-Time Augmented Reality Annotation for Surgical Education during Laparoscopic Surgery: Results from a Single-Center Randomized Controlled Trial and Future Aspects.

BACKGROUND: We developed an interactive augmented reality tool (HoloPointer) that enables real-time annotation on a laparoscopy monitor for intraoperative guidance. This application operates exclusively via verbal commands and head movements to ensure a sterile workflow. STUDY DESIGN: Purpose of this randomized controlled clinical trial was to evaluate the integration of this new technology into the operating room. This prospective single-center study included 32 elective laparoscopic cholecystectomies (29 surgical teams, 15 trainees, and 13 trainers). The primary objective and assessment measure was the HoloPointer's influence on surgical performance (subjective assessment, global operative assessment of laparoscopic skills [GOALS] and critical view of safety [CVS]). The secondary objectives and outcome variables were its influence on operation time, quality of assistance (5-point Likert scale), and user-friendliness (system usability scale, 0 to 100 points). RESULTS: Gestural corrections were reduced by 59.4% (4.6 SD 8.1 vs 1.9 SD 4.7, p > 0.05) and verbal corrections by 36.1% (17.8 SD 12.9 vs 11.4 SD 8.1, p > 0.05). Subjective surgical performance could be improved by 84.6% of participants. No statistically significant differences were observed for objective parameters GOALS, CVS, and operation time. In the system usability scale, the application achieved an average score of 72.5 SD 16.3 (good user-friendliness). Of the participants, 69.2% wanted to use the HoloPointer more frequently. CONCLUSIONS: The majority of trainees improved their surgical performance using the HoloPointer in elective laparoscopic cholecystectomies, and the rate of classic but potentially misleading corrections was noticeably reduced. The HoloPointer has the potential to improve education in minimally invasive surgery.

[Liver Surgery 4.0 - Planning, Volumetry, Navigation and Virtual Reality]. / Leberchirurgie 4.0 - OP-Planung, Volumetrie, Navigation und Virtuelle Realität.

Due to the optimisation of conservative treatment, the improvement of imaging methods and the continuous development of surgical techniques, the borders of resectability in liver surgery have changed significantly in recent decades.Thanks to numerous technical developments, in particular three-dimensional segmentation, preoperative planning and orientation during the operation itself, can now be facilitated, especially in complex procedures.New technologies such as 3D printing as well as virtual and augmented reality offer additional display options for the patients' individual anatomy. Various intraoperative navigation options are intended to make preoperative planning available in the operating room in order to increase patient safety.This review article is intended to provide an overview of the current state of available technologies and an outlook into the operating theatre of the future.

Patient-individualized resection planning in liver surgery using 3D print and virtual reality (i-LiVR)-a study protocol for a prospective randomized controlled trial.

BACKGROUND: A multitude of different diseases-benign and malign-can require surgery of the liver. The liver is an especially challenging organ for resection planning due to its unique and interindividually variable anatomy. This demands a high amount of mental imagination from the surgeon in order to plan accordingly - a skill, which takes years of training to acquire and which is difficult to teach. Since the volume of the functional remnant liver is of great importance, parenchyma sparing resections are favoured. 3D reconstructions of computed tomography imaging enable a more precise understanding of anatomy and facilitate resection planning. The modality of presentation of these 3D models ranges from 2D monitors to 3D prints and virtual reality applications. METHODS: The presented trial compares three different modes of demonstration of a 3D reconstruction of CT scans of the liver, which are 3D print, a demonstration on a regular computer screen or using a head-mounted virtual reality headset, with the current gold standard of viewing the CT scan on a computer screen. The group size was calculated with n=25 each. Patients with major liver resections in a laparoscopic or open fashion are eligible for inclusion. Main endpoint is the comparison of the quotient between planned resection volume and actual resection volume between these groups. Secondary endpoints include usability for the surgical team as well as patient specifics and perioperative outcome measures and teaching issues. DISCUSSION: The described study will give insight in systematic planning of liver resections and the comparison of different demonstration modalities of 3D reconstruction of preoperative CT scans and the preference of technology. Especially teaching of these demanding operations is underrepresented in prior investigations. TRIAL REGISTRATION: Prospective trials registration at the German Clinical Trials register with the registration number DRKS00027865 . Registration Date: January 24, 2022.