Virtual reality laparoscopic skill assessment in microgravity

BACKGROUND: The objective of the study was to assess if performance of basic laparoscopic skills on a virtual reality (VR) simulator is impaired in microgravity relative to normal gravitational influences. MATERIALS AND METHODS: Fourteen subjects with various educational backgrounds underwent basic laparoscopy skill training for five consecutive days on the ground before flying aboard NASA's KC-135 zero-gravity laboratory. The participants performed basic laparoscopic exercises (clip applying, grasping, cutting, and suturing) on a VR laparoscopy simulator, both on the ground and during 25-s microgravity windows in parabolic flight. Skill levels after ground training were compared with skill levels in performing the same tasks in microgravity. Blinded reviewers measured the number of tasks successfully completed, tissue damage number, left and right hand path lengths during task execution, and percentage of task attempts that resulted in successful completion. RESULTS: A significant increase in tissue injury (t test, P < 0.05) and task erosion were seen in clip applying, cutting, and grasping in microgravity (45%, 20% and 57% decrease in task attempts that resulted in a successful completion, respectively). However, there was no significant difference in the left and right hand path lengths, and the total number of tasks successfully completed on the ground versus in microgravity, for any of the four laparoscopic exercises (t test, P > 0.05). CONCLUSION: This study demonstrates decreased efficiency and increased injury to the simulated tissues in performing laparoscopic skills during microgravity as compared to performing these skills in standard gravitational influence. Additional experiments are indicated to further develop and validate VR microgravity surgical simulation.     

虚拟现实辅助小切口锁骨骨折内固定术

[目的]介绍虚拟现实辅助小切口治疗锁骨骨折的技术方法与初步临床效果。[方法]2016年7月~2019年9月在本院对35例锁骨骨折采用虚拟现实辅助小切口内固定治疗。术前行锁骨薄层CT扫描,数据导入到Mimics17.0软件中后,建立三维虚拟现实模型,对骨折进行复位,并对解剖型锁钉接骨板预选和预折弯,测量螺钉的直径和长度。术中于锁骨上两端分别做2 cm的切口,使用剥离器建立皮下通道后,插入预选的已塑形接骨板,分别在预置钉孔进行钻孔,拧入预选规格的螺钉。[结果]35例患者均顺利完成手术,无血管、神经损伤,手术操作时间(35.93±11.11)min,术中出血量(38.52±9.38)ml、透视次数(5.32±1.71)次,住院时间(6.79±0.61)d。仅1例患者切口浅表感染,经换药后愈合。随访6个月以上,随时间推移,患者疼痛逐渐减轻,患者肩部功能不断改善,末次随访时Neer评分为(94.58±2.18)分。[结论]虚拟现实辅助小切口治疗锁骨骨折患者,提升手术的精准性,减少医源性损伤。     

Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). This report presents the results of the first Vietnam combat veteran with PTSD to have been treated with VRE. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-month follow-up.     

虚拟现实技术与新型整形外科教学

由于整形外科病种繁杂多样、临床患者特异性较高,其疾病治疗的学习缺乏可重复性。虚拟现实技术可提供三维、无风险的手术环境,使学习者可在正式手术前进行演练操作并尝试独立完成手术。但是,单纯应用虚拟现实技术进行教学仍有不足,该技术无法完全模拟临床复杂肠道、血流动力学等。若能在原本的学习循环中加入新型VR(Virtual reality)模拟技术,可借由模拟的手术环境弥补整形外科教学中存在的学习曲线长且复杂术式难以掌握的缺点,从而形成"Observation, thinking, experience, action and teaching",即"临床观摩、临床问题思考、手术操作演练、独立手术与教学"的新型循环学习模式。该模式有效突破了传统的由课堂到手术台的学习平台期,使整形外科领域能够快速且高质量地培养更多的专业医生。     

Virtual reality digital surgical planning for jaw reconstruction: a usability study

Background

Digital surgical planning (DSP) has revolutionized the preparation and execution of the management of complex head and neck pathologies. The addition of virtual reality (VR) allows the surgeon to have a three-dimensional experience with six degrees of freedom for visualizing and manipulating objects. This pilot study describes the participants experience with the first head and neck reconstructive VR-DSP platform.

Methods

An original VR-DSP platform has been developed for planning the ablation and reconstruction of head and neck pathologies. A prospective trial utilizing this platform involving reconstructive surgeons was performed. Participants conducted a simulated VR-DSP planning session, pre- and post-questionnaire as well as audio recordings allowing for qualitative analysis.

Results

Thirteen consultant reconstructive surgeons representing three surgical backgrounds with varied experience were recruited. The majority of surgeons had no previous experience with VR. Based on the system usability score, the VR-DSP platform was found to have above average usability. The qualitative analysis demonstrated the majority had a positive experience. Participants identified some perceived barriers to implementing the VR-DSP platform.

Conclusions

Virtual reality-digital surgical planning is usable and acceptable to reconstructive surgeons. Surgeons were able to perform the steps in an efficient time despite limited experience. The addition of VR offers additional benefits to current VSP platforms. Based on the results of this pilot study, it is likely that VR-DSP will be of benefit to the reconstructive surgeon.     

Virtual reality for acute and chronic pain management in adult patients: a narrative review

Virtual reality is a computer-generated environment that immerses the user in an interactive artificial world. This ability to distract from reality has been utilised for the purposes of providing pain relief from noxious stimuli. As technology rapidly matures, there is potential for anaesthetists and pain physicians to incorporate virtual reality devices as non-pharmacological therapy in a multimodal pain management strategy. This systematic narrative review evaluates clinical studies that used virtual reality in adult patients for management of acute and chronic pain. A literature search found 690 citations, out of which 18 studies satisfied the inclusion criteria. Studies were assessed for quality using the Jadad and Nottingham-Ottawa Scales. Agreement on scores between independent assessors was 0.87 (95%CI 0.73–0.94). Studies investigated virtual reality use: intra-operatively; for labour analgesia; for wound dressing changes; and in multiple chronic pain conditions. Twelve studies showed reduced pain scores in acute or chronic pain with virtual reality therapy, five studies showed no superiority to control treatment arms and in one study, the virtual reality exposure group had a worsening of acute pain scores. Studies were heterogeneous in: methods; patient population; and type of virtual reality used. These limitations suggest the evidence-base in adult patients is currently immature and more rigorous studies are required to validate the use of virtual reality as a non-pharmacological adjunct in multimodal pain management.     

Computer Assisted Knee Surgery: Diagnostics and Planning of Knee Surgey

Cruciate ligament rupture, a common injury among young active adults, disrupts the knee's complex movement and often leads to premature degenerative arthritis of the joint. Prosthetic cruciate ligaments can be used for replacement but often fail owing to incorrect surgical placement.

To aid in the planning of cruciate prosthetic substitution, a computerized system has been developed to provide the surgeon with a virtual interface allowing accurate visualization of three-dimensional (3D) bone structure and movement normally hidden beneath layers of soft tissue.

Preoperatively, precise in vivo kinematics are quantified with the help of 3D medical images.

Three-dimensional imagery techniques based on computed tomography (CT) have been developed to obtain accurate 3D reconstruction of knee geometry preoperatively. The system allows the surgeon to know the real-time spatial position of the patient via magnetic position and orientation sensors attached noninvasively onto the femur and tibia via a new attachment system. An interactive computer program has been developed to allow the user to simulate different prosthetic ligament insertions and compute elongation, bending, and torsion values that will be imposed on the prosthesis. Through comparison with cadaver studies and a perturbation analysis, the system is shown to be sufficiently accurate to predict certain in vivo ligament bending and torsion deformations.     

Comparison Of Short-Term Effects Of Virtual Reality and Short Foot Exercises In Pes Planus

BackgroundVirtual reality exercises (VRE) offers functional, multipurpose usage with a motivational approach. This study aimed to compare VRE and short foot exercises (SFE) in individuals with flexible pes planus.MethodsForty participants with pes planus were assigned to the SFE group (n = 20) or VR exercise group (n = 20). Both groups performed exercises three times a week for four weeks. The groups were assessed with a navicular drop test for the height of the medial longitudinal arch, craig Test for femoral anteversion, Star Excursion Test for balance,10 step test for performance.ResultsFor two groups there is a statistically significant difference between before and after treatments(p < 0.05). There is no difference between VRE and SFE groups after treatments for all parameters(p > 0.05).ConclusionsTwo different 4-week-exercise programs for pes planus have a similar effect on performance, balance, and navicular drop values in both groups. It was considered that the practice of VR exercises like short foot exercises could also address rehabilitation goals, which included improving balance, performance, and foot posture.ClinicalTrials.gov IdentifierNCT04283357.     

Virtual Reality Simulators: Valuable Surgical Skills Trainers or Video Games?

BackgroundVirtual reality (VR) and physical model (PM) simulators differ in terms of whether the trainee is manipulating actual 3-dimensional objects (PM) or computer-generated 3-dimensional objects (VR). Much like video games (VG), VR simulators utilize computer-generated graphics. These differences may have profound effects on the utility of VR and PM training platforms. In this study, we aimed to determine whether a relationship exists between VR, PM, and VG platforms.MethodsVR and PM simulators for laparoscopic camera navigation ([LCN], experiment 1) and flexible endoscopy ([FE] experiment 2) were used in this study. In experiment 1, 20 laparoscopic novices played VG and performed 0° and 30° LCN exercises on VR and PM simulators. In experiment 2, 20 FE novices played VG and performed colonoscopy exercises on VR and PM simulators.ResultsIn both experiments, VG performance was correlated with VR performance but not with PM performance. Performance on VR simulators did not correlate with performance on respective PM models.ConclusionsVR environments may be more like VG than previously thought.