Exploring the use of virtual reality in surgical education

Virtual reality(VR)technologies have rapidly developed in the past few years.The most common application of the technology,apart from gaming,is for educational purposes.In the field of healthcare,VR technologies have been applied in several areas.Among them is surgical education.With the use of VR,surgical pathways along with the training of surgical skills can be explored safely,in a cost-effective manner.The aim of this mini-review was to explore the use of VR in surgical education and in the 3D reconstruction of internal organs and viable surgical pathways.Finally,based on the outcomes of the included studies,an ecosystem for the implementation of surgical training was proposed.

Telementoring in education of laparoscopic surgeons: An emerging technology

Laparoscopy, minimally invasive and minimal access surgery with more surgeons performing these ad-vanced procedures. We highlight in the review several key emerging technologies such as the telementor-ing and virtual reality simulators, that provide a solid ground for delivering surgical education to rural area and allow young surgeons a safety net and confidence while operating on a newly learned technique.

Current and future role of three-dimensional modelling technology in rectal cancer surgery:A systematic review

BACKGROUND Three-dimensional(3D)modelling technology translates the patient-specific anatomical information derived from two-dimensional radiological images into virtual or physical 3D models,which more closely resemble the complex environment encountered during surgery.It has been successfully applied to surgical planning and navigation,as well as surgical training and patient education in several surgical specialties,but its uptake lags behind in colorectal surgery.Rectal cancer surgery poses specific challenges due to the complex anatomy of the pelvis,which is difficult to comprehend and visualise.AIM To review the current and emerging applications of the 3D models,both virtual and physical,in rectal cancer surgery。METHODS Medline/PubMed,Embase and Scopus databases were searched using the keywords“rectal surgery”,“colorectal surgery”,“three-dimensional”,“3D”,“modelling”,“3D printing”,“surgical planning”,“surgical navigation”,“surgical education”,“patient education”to identify the eligible full-text studies published in English between 2001 and 2020.Reference list from each article was manually reviewed to identify additional relevant papers.The conference abstracts,animal and cadaveric studies and studies describing 3D pelvimetry or radiotherapy planning were excluded.Data were extracted from the retrieved manuscripts and summarised in a descriptive way.The manuscript was prepared and revised in accordance with PRISMA 2009 checklist.RESULTS Sixteen studies,including 9 feasibility studies,were included in the systematic review.The studies were classified into four categories:feasibility of the use of 3D modelling technology in rectal cancer surgery,preoperative planning and intraoperative navigation,surgical education and surgical device design.Thirteen studies used virtual models,one 3D printed model and 2 both types of models.The construction of virtual and physical models depicting the normal pelvic anatomy and rectal cancer,was shown to be feasible.Within the clinical context,3D models were used to identify vascular anomalies,for surgical planning and navigation in lateral pelvic wall lymph node dissection and in management of recurrent rectal cancer.Both physical and virtual 3D models were found to be valuable in surgical education,with a preference for 3D printed models.The main limitations of the current technology identified in the studies were related to the restrictions of the segmentation process and the lack of 3D printing materials that could mimic the soft and deformable tissues.CONCLUSION 3D modelling technology has potential to be utilised in multiple aspects of rectal cancer surgery,however,it is still at the experimental stage of application in this setting.

Performance of single versus two operators in laparoscopic surgery

Aim:To examine the significance of team collaboration in the context of complex laparoscopic surgery,laparoscopic tasks performed by single operators are compared against that of dyad teams.Methods:The laparoscopic tasks require subjects to reach,grasp and transport a ring through a rollercoaster obstacle using a pair of laparoscopic graspers.The task was performed either bimanually(using both hands)or unimanually(using their preferred hands)in a dyad team.Results:Twelve participants completed all the tasks.The dyad teams recorded significantly greater number of anticipatory movements than individuals who performed the task bimanually(p<0.05).However,there is no significant difference in the task completion time(p=0.701)and the number of errors(p=0.860)recorded between the dyad and the bimanual group.Conclusion:Compared to a single operator,dyad operators performed the task with greater number of anticipatory movements.The increased movement synchronization can help benefit surgical education and team training.

The status of surgical simulation

ultiple academic organizations, administrative _authorities, and some commercial bodies in medicine have accepted the fact that simulation has become crucial and brought tremendous changes in surgical education and training] When integrated into surgical education and training system, simulation not only improves the quality of surgical service by upgrading surgeons＇ skills and decreasing time to the mastery of various critical techniques, but also secures the safety of patients.

Evaluation of an interactive virtual surgical rotation during the COVID-19 pandemic

Objective:To evaluate medical student and attending surgeon experiences with a novel interactive virtual Otolaryngology-Head and Neck Surgery(OHNS)medical student elective during the COVID-19 pandemic.Study Design:A virtual OHNS elective was created,with three components:(1)interactive virtual operating room(OR)experience using live-stream video-conferencing,(2)telehealth clinic,(3)virtual didactics.Setting:OHNS Department at the University of Pennsylvania(May 2020 to June 2020).Methods:Six medical students from the University of Pennsylvania;five attending otolaryngologists.Two surveys were designed and distributed to participating medical students and attending surgeons.Surveys included 5-point Likert scale items,with 1 indicating"not at all"and 5 indicating"very much so".Results:Response rate was 100%for both surveys.Students on average rated the educational value of the telehealth experience as 4.2±1.2,and the virtual OR experience as 4.0±0.6.Most students(n=5,83%)indicated that they had enough exposure to faculty they met on this rotation to ask for a letter of recommendation(LOR)for residency if needed,while attending surgeons had an average response of 3.0±1.0 when asked how comfortable they would feel writing a LOR for a student they met through the rotation.A majority of students(n=4,67%)felt they connected enough with faculty during the rotation to ask for mentorship.Half the students(n=5,50%)indicated that the rotation allowed them to evaluate the department's culture either"extremely well"or"somewhat well".Conclusions:Overall,participating students described this innovative virtual surgical rotation as an educationally and professionally valuable experience.With the continued suspension of visiting student rotations due to the COVID-19 pandemic,this virtual model may have continued relevance to medical education.

The virtual peripheral nerve academy:education for the identification and treatment of peripheral nerve disorders

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders.However,medical school curricula are profoundly deficient in peripheral nerve education.This lack of knowledge within the healthcare profession may cause inadequate patient care.We developed the Virtual Peripheral Nerve Academy(VPNA)as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system(PNS).Students are introduced to the PNS through virtual 3D rendering of the human body,wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve.PNS structures that are absent from traditional texts are included in this visualization,ranging from the innervation of joints to the normal anatomic variation required for differential diagnosis of pain after an injury.Detailed modules on peripheral nerve disorders allow students to observe pathophysiological mechanisms,associated symptomatology,and appropriate treatments.Students are briefed on a patient clinical case,then interact with a patient avatar to learn the appropriate diagnostics,including physical exam maneuvers and electrodiagnostic testing.Interactive modules on peripheral nerve surgeries detail surgical techniques.The VPNA data and analytics dashboards allow medical students and course instructors to assess skill improvement and identify specific learning needs.The built-in learner management system and availability on both computer-based and virtual reality platforms facilitate integration into any existing medical school curricula.Ultimately,this immersive technology enables every medical student to learn about the peripheral nervous system and gain competency in treating real-life nerve pathologies.

Augmented reality assisted surgery： a urologic training tool

Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.

“PERISH”fl owchart for selection of the patients with resectable hepatocellular carcinoma

A selection of patients with hepatocellular carcinoma(HCC)for surgical resection is crucial and algorithms/staging systems help surgeons to decide on a standard treatment for each patient and each HCC stage.However,there are always diffi culties in remembering and/or recalling the contents of the algorithms/staging systems.Moreover,most algorithms/staging systems do not include data about the extent of hepatectomy,intra-hepatic distribution of tumor(s),and technical feasibility of resection,all of which are vital in the surgeons’decision-making process.Here,we aimed to present a simple and handy mnemonic acronym for selecting resectable HCCs in surgical practice.This was reproduced from the existing well-known staging systems.The designed mnemonic acronym is a phrase“PERISH”and it includes asking for Performance of patient,Extra-hepatic disease,Reserve of the liver,Intra-hepatic distribution,Stratifying risk factors,and Hepatectomy size in order.Performance based on whether the patient is mostly bedridden or not should be the fi rst step of evaluation.Next,asking for suspicious metastasis as bone pain and radiological evaluation of abdomen/thorax is mandatory.The calculation of Child-Pugh score is only the third step.Good candidates for surgical resection should be Child-Pugh“A”with normal bilirubin levels.Technical feasibility of resection,according to the intra-hepatic distribution of tumor(s)should be done later,and the candidates preferably should not have portal hypertension(no splenomegaly,no thrombocytopenia).If the patient fulfi lls all the previous steps,the surgeon may perform indo-cyanine green clearance test.Consequently,following the PERISH fl owchart may prevent“perish”of the surgeons while selecting the appropriate resectable HCCs.