What Is Your Reality? Virtual, Augmented, and Mixed Reality in Plastic Surgery Training, Education, and Practice

Artificial Intelligence Applications in Pediatric Craniofacial Surgery

Artificial intelligence is rapidly transforming pediatric craniofacial surgery by enhancing diagnostic accuracy, improving surgical precision, and optimizing postoperative care. Machine learning and deep learning models are increasingly used to analyze complex craniofacial imaging, enabling early detection of congenital anomalies such as craniosynostosis, and cleft lip and palate. AI-driven algorithms assist in preoperative planning by identifying anatomical abnormalities, predicting surgical outcomes, and guiding personalized treatment strategies. In cleft lip and palate care, AI enhances prenatal detection, severity classification, and the design of custom therapeutic devices, while also refining speech evaluation. For craniosynostosis, AI supports automated morphology classification, severity scoring, and the assessment of surgical indications, thereby promoting diagnostic consistency and predictive outcome modeling. In orthognathic surgery, AI-driven analyses, including skeletal maturity evaluation and cephalometric assessment, inform optimal timing and diagnosis. Furthermore, in cases of craniofacial microsomia and microtia, AI improves phenotypic classification and surgical planning through precise intraoperative navigation. These advancements underscore AI's transformative role in diagnostic accuracy, and clinical decision-making, highlighting its potential to significantly enhance evidence-based pediatric craniofacial care.

Comparison of Remote Mixed Reality Versus In-person Training of Ultrasound-guided Percutaneous Nephrolithotomy With Urological Residents

OBJECTIVE

To compare remotely to in-person training during image-guided percutaneous nephrolithotomy (PCNL), we used mixed reality (MR), smart glasses, and a validated hydrogel simulation model to test surgical education uptake with urological residents.

METHODS

Twelve urology residents were randomized into 2 learning groups (MR-first or in-person-first) and completed a pre-test, MR or IP-guided training sessions, mid test, cross-over into MP or IP-guided training, post-test, and a retention test 2 months post-training to evaluate upper and lower pole access and balloon dilatation. MR sessions utilized Vuzix smart glasses and HelpLightning MR software to allow the instructor to remotely instruct the student and share their first-person perspective. Performance was assessed against a checklist of metrics including attempts for access, procedure time, and a model specific checklist. Learner perspectives were assessed after each training session using 5-point Likert scales and open form comments.

RESULTS

Overall attempt scores improved significantly for lower pole and upper pole procedures from pre- to mid-test and pre- to post-test (LP: 50% vs 74.5%, P=.0019, 50% vs 82.8%, P=.001; UP: 43.6% vs 63.75%, P=.0002; 43.6% vs 70.5%, P=3.6e-05) in both MR and IP cohorts. Learner evaluations suggested that the majority still prefer IP instruction, citing technological difficulties.

CONCLUSION

MR-based remote learning is equally effective when compared to in-person instruction of US-PCNL.

Application and exploration of interprofessional education in the teaching of plastic and reconstructive surgery: a narrative review

The growing discussion on "interdisciplinary integration" brings attention to the "interprofessional education" (IPE) in the field of plastic surgery. IPE not only improves the precision and effectiveness of plastic and reconstructive surgery but also plays an important role in personalized treatment. Whereas, the implementation of IPE in plastic and reconstructive surgery field faces huge difficulties such as technology combination, standard making, and lacking of qualified talents. This article individually summarizes the latest developments in the integration of plastic and reconstructive surgery with engineering, basic science, and human science. It looks forward to the future practice and innovation of IPE in the field of plastic and reconstructive surgery, analyzes the challenges in cultivating innovative professional talents, and proposes methods to overcome these difficulties in a way that invites further discussion.

Evaluating Plastic Surgery Resident Satisfaction Globally: Predictors and Recommendations for Training Enhancement

BACKGROUND

Measures of quality in resident training in plastic and reconstructive surgery (PRS) programs are scarce and often methodologically inconsistent. Our research provides insights from current PRS trainees globally, mapping their training inputs, expected outputs, and recommendations for program improvements.

METHODS

A global online survey was conducted among PRS residents across 70 countries to gauge their satisfaction with residency training, capturing training inputs such as the number of surgeries attended and seminars they participated in. We also extracted residents' proposed recommendations for program improvement. We investigated the explanatory role of training inputs, demographics, hospital characteristics, and country income on resident satisfaction and graduate competence.

RESULTS

The analysis incorporated data from 518 PRS residents. On average, residents attended 9.8 surgeries and 1.3 seminars per week. Simultaneously, there was a positive correlation between the perceived level of professional competency and training inputs, particularly seminars attended (p - value = 0.001). Male residents tended to report higher satisfaction (p - value = 0.045) with their training (67%) compared with their female counterparts (58%), while those with family responsibilities also demonstrated slightly higher satisfaction levels.

CONCLUSIONS

Our analysis expands the evidence base regarding a "global hunger" for more comprehensive seminar-based and hands-on surgical training. Resident recommendations on program improvement reveal the need to address gaps, particularly in aesthetic surgery training. The development of healthcare business models that allow for aesthetic procedures in training institutions is crucial in the promotion of aesthetic surgery training during residency. Policymakers, program directors, and stakeholders across the world can leverage these findings to formulate policies addressing the weaknesses of training programs.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of augmented reality with other teaching methods in learning anatomy: A systematic review

Augmented reality (AR) has been investigated as an engaging educational tool that motivates undergraduate health science students to learn human anatomy. AR technology is developing rapidly, supporting medical education by presenting models of human anatomy as digital objects overlaid in the real world via mobile or head-mounted display (HMD). The purpose of this systematic review is to provide a post-pandemic analysis of AR compared with other methods for teaching anatomy and to determine the effects of AR on learning outcomes (LOs). Original research published between January 2020 and April 2024 was obtained from the WOS, Scopus, MEDLINE(Ovid), EMBASE, and PubMed databases, following PRISMA 2020 protocols. Articles included for analysis compared AR with alternative pedagogical methods of teaching undergraduate human anatomy. Studies that described AR as "mixed reality" (MR) were included, while those describing "virtual reality" (VR) were not considered. Risk of bias and limitations in individual studies were assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Data were synthesized using a convergent integrated approach with LOs tabulated for visual analysis. A total of 17 articles were eligible for review: nine studies comparing AR via HMD hardware, and eight comparing mobile AR. The LOs of 12 studies were overwhelmingly reported as non-significant. Insufficient data precluded an accurate meta-analysis of LOs, and critical analysis revealed a considerable risk of bias and lack of justified methodology. While AR holds potential for supporting undergraduate students in learning anatomy, definitive outcomes from the current literature are limited by the heterogeneous nature of the studies and inconsistent use of terminology. It is recommended that future research employs professional AR technologies and incorporates the perspectives of university educators to ensure reliable outcomes that can direct the further development of AR technology in medical education.

Integrating AI into Breast Reconstruction Surgery: Exploring Opportunities, Applications, and Challenges

Background: Artificial intelligence (AI) has significantly influenced various sectors, including healthcare, by enhancing machine capabilities in assisting with human tasks. In surgical fields, where precision and timely decision-making are crucial, AI's integration could revolutionize clinical quality and health resource optimization. This study explores the current and future applications of AI technologies in reconstructive breast surgery, aiming for broader implementation. Methods: We conducted systematic reviews through PubMed, Web of Science, and Google Scholar using relevant keywords and MeSH terms. The focus was on the main AI subdisciplines: machine learning, computer vision, natural language processing, and robotics. This review includes studies discussing AI applications across preoperative, intraoperative, postoperative, and academic settings in breast plastic surgery. Results: AI is currently utilized preoperatively to predict surgical risks and outcomes, enhancing patient counseling and informed consent processes. During surgery, AI supports the identification of anatomical landmarks and dissection strategies and provides 3-dimensional visualizations. Robotic applications are promising for procedures like microsurgical anastomoses, flap harvesting, and dermal matrix anchoring. Postoperatively, AI predicts discharge times and customizes follow-up schedules, which improves resource allocation and patient management at home. Academically, AI offers personalized training feedback to surgical trainees and aids research in breast reconstruction. Despite these advancements, concerns regarding privacy, costs, and operational efficacy persist and are critically examined in this review. Conclusions: The application of AI in breast plastic and reconstructive surgery presents substantial benefits and diverse potentials. However, much remains to be explored and developed. This study aims to consolidate knowledge and encourage ongoing research and development within the field, thereby empowering the plastic surgery community to leverage AI technologies effectively and responsibly for advancing breast reconstruction surgery.

Reducing the risk of unfavourable fractures in Le Fort III osteotomy via a navigation-guided technique

The aim of this study was to investigate the clinical feasibility of reducing the risk of unfavourable fractures during Le Fort III osteotomy by using a navigation-guided technique. A study was carried out involving 20 patients with Crouzon syndrome treated with Le Fort III osteotomy and distraction osteogenesis from 2018 to 2023 at the International Hospital of Peking University. The Le Fort III osteotomy procedure in experimental group (9 patients) was carried out under the guidance of navigation technique, while in historical control group (11 patients) was carried out by free hand. Immediate postoperative CT scans were acquired within 24h after surgery to observe the osteotomy lines and detect unfavourable fracture lines. There were 4 patients with unfavourable fractures in the navigation group (4/9 = 44%) while 10 patients in the freehand group (10/11 = 91%), with a statistically significant difference in the probability of unfavourable fracture and the number of fracture lines between the two groups (P < 0.05). The difference in unfavourable fracture incidence in the two groups was significant in zygomatic area (P < 0.05) while not significant in mid-palatal area (P > 0.05). And the surgical duration of the navigation group was significantly shorter than that of the freehand group (216 min vs 280 min) (P < 0.05). The above findings suggest that the navigation-guided technique is effective in reducing the risk of unfavourable fractures in Le Fort III osteotomy procedure and decreasing the surgical duration.

3D-SARC: A Pilot Study Testing the Use of a 3D Augmented-Reality Model with Conventional Imaging as a Preoperative Assessment Tool for Surgical Resection of Retroperitoneal Sarcoma

BACKGROUND

Retroperitoneal sarcomas (RPSs) present a surgical challenge, with complex anatomic relationships to organs and vascular structures. This pilot study investigated the role of three-dimensional (3D) augmented reality (3DAR) compared with standard imaging in preoperative planning and resection strategies.

METHODS

For the study, 13 patients who underwent surgical resection of their RPS were selected based on the location of their tumor (right, left, pelvis). From the patients' preoperative computed tomography (CT) scans, 3DAR models were created using a D2P program and projected by an augmented-reality (AR) glass (Hololens). The 3DAR models were evaluated by three experienced sarcoma surgeons and compared with the baseline two-dimensional (2D) contrast-enhanced CT scans.

RESULTS

Three members of the surgical team evaluated 13 models of retroperitoneal sarcomas, resulting in a total of 26 responses. When the surgical team was asked to evaluate whether the 3DAR better prepared the surgeon for planned surgical resection, 10 responses favored the 3DAR, 5 favored the 2D CT scans and 11 showed no difference (p = 0.074). According to 15 (57.6 %) of the 26 responses, the 3DAR offered additional value over standard imaging in the preoperative planning (median score of 4; range, 1-5). The median stated likelihood that the surgeons would consult the 3DAR was 5 (range, 2-5) for the preoperative setting and 3 (range, 1-5) for the intraoperative setting.

CONCLUSIONS

This pilot study suggests that the use of 3DAR may provide additional value over current standard imaging in the preoperative planning for surgical resection of RPS, and the technology merits further study.

Virtual Loupes: A Pilot Study on the Use of Video Passthrough Augmented Reality in Plastic Surgery

BACKGROUND

Plastic surgeons use loupes or operative microscope to aid in tissue dissection and anastomosis of structures. These devices have their own limitations in areas of visualization and weight. Current uses of augmented and virtual reality in surgery have been limited to operative planning and simulation. We present a proof of concept that harnesses video passthrough AR technology to augment the capabilities of loupes.

METHODS

We first evaluated methods of gaze-based eye tracking to enable digital magnification. Using the Varjo XR-1 mixed reality headset, we compared discrete zoom through displayed pop-up menu vs continuous zoom through eye winking. Six participants were recruited to perform skin suturing simulation and completed a survey and interview. Next we assessed the performance and limitations of AR digital magnification. Varjo XR-3 was utilized to address the hardware limitations. Participants performed anastomotic suturing tasks with progressively finer suture, then completed a survey and interview.

FINDINGS

There was no strong preference between zoom methods, although participants felt the discrete zoom was easier to use. Participants had difficulty determining depth and visualizing the suture due to limitations of digital magnification. Using Wilcoxon rank sum test to examine differences in system usability scale, the Phase 2 user experience had significant difference in percentile distribution (P 0.0390).

CONCLUSION

Virtual loupes may be a valuable tool for plastic surgeons, with potential for variable magnification and advanced visualization. Improvements in the hardware yielded higher ratings of system usability and user experience. Further development is needed to address the limitations of existing devices.

Characterizing the untapped potential of virtual reality in plastic and reconstructive surgical training: A systematic review on skill transferability

Virtual reality (VR) integration into surgical education has gained immense traction by invigorating skill-building in ways that are unlike the traditional modes of training. This systematic review unites current literature relevant to VR in surgical education to showcase tool transferability, and subsequent impact on knowledge acquisition, skill development, and technological innovation. This review followed the PRISMA guidelines and included three databases. Among the 1926 studies that were screened, 31 studies met the inclusion criteria. ChatGPT assisted in generating variables for data extraction, and the authors reached unanimous consensus on 13 variables that provided a framework for assessing VR attributes. Surgical simulation was examined in 26 studies (83.9%). VR applications incorporated anatomy visualization (83.9%), procedure planning (67.7%), skills assessment (64.5%), continuous learning (41.9%), haptic feedback (41.9%), research and innovation (41.9%), case-based learning (22.6%), improved skill retention (19.4%), reduction of stress and anxiety (16.1%), and remote learning (12.9%). No instances of VR integration addressed patient communication or team-based training. Novice surgeons benefited the most from VR simulator experience, improving their confidence and accuracy in tackling complex procedural tasks, as well as decision-making efficiency. Enhanced dexterity compared to traditional modes of surgical training was also notable. VR confers significant potential as an adjunctive teaching method in plastic and reconstructive surgery (PRS). Studies demonstrate the utility of virtual simulation in knowledge acquisition and skill development, though they lack targeted approaches for augmenting training related to collaboration and patient communication. Given the underrepresentation of PRS among surgical disciplines regarding VR implementation in surgical education, longitudinal curriculum integration and PRS-specific technologies should be further investigated.

Application of three-dimensional printing in plastic surgery: a bibliometric analysis

Recent years have seen the publication of numerous papers on the application of three-dimensional (3D) printing in plastic surgery. Despite this growing interest, a comprehensive bibliometric analysis of the field has yet to be conducted. To address this gap, we undertook a bibliometric study to map out the knowledge structure and identify research hotspots related to 3D printing in plastic surgery. We analyzed publications from 1995 to 2024, found in the Web of Science Core Collection (WoSCC), utilizing tools such as VOSviewer, CiteSpace, and the R package "bibliometrix". Our analysis included 1,057 documents contributed by 5,545 authors from 1,620 organizations across 71 regions, and these were published in 400 journals. We observed a steady growth in annual publications, with Europe, Asia, North America, and Oceania leading in research output. Notably, Shanghai Jiao Tong University emerged as a primary research institution in this domain. The Journal of Craniofacial Surgery and Journal of Oral and Maxillofacial Surgery have made significant contributions to the field, with Thieringer, Florian M being the most prolific and frequently cited author. Key areas of focus include medical education and surgical procedures, with "3D printing", "virtual surgical planning" and "reconstructive/orthognathic surgery" highlighted as future research hotspots. Our study provides a detailed bibliometric analysis, revealing the evolution and progress of 3D printing technologies in plastic surgery. As these technologies continue to advance, their impact on clinical practice and patient lives is expected to be profound.

An Oncoplastic Approach to Primary Pediatric Pterygomaxillary Osteosarcoma

Osteosarcomas arising within the pterygomaxillary/infratemporal fossa region are rare among the pediatric population. Survival rates are most influenced by tumor resection with negative margins, which can be dependent on surgical accessibility of the tumor site. The pterygomaxillary/infratemporal fossa location poses several challenges to safe and adequate tumor resection, including proximity of the facial nerve and great vessels and scarring associated with traditional transfacial approaches. In this article, we present the case of a 6-year-old boy with an osteosarcoma of the left pterygomaxillary/infratemporal fossa region successfully managed with an "oncoplastic" approach, incorporating the use of CAD/CAM and mixed reality technologies.

From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier

BACKGROUND

 Augmented reality (AR) and virtual reality (VR)-termed mixed reality-have shown promise in the care of operative patients. Currently, AR and VR have well-known applications for craniofacial surgery, specifically in preoperative planning. However, the application of AR/VR technology to other reconstructive challenges has not been widely adopted. Thus, the purpose of this investigation is to outline the current applications of AR and VR in the operative setting.

METHODS

 The literature pertaining to the use of AR/VR technology in the operative setting was examined. Emphasis was placed on the use of mixed reality technology in surgical subspecialities, including plastic surgery, oral and maxillofacial surgery, colorectal surgery, neurosurgery, otolaryngology, neurosurgery, and orthopaedic surgery.

RESULTS

 Presently, mixed reality is widely used in the care of patients requiring complex reconstruction of the craniomaxillofacial skeleton for pre- and intraoperative planning. For upper extremity amputees, there is evidence that VR may be efficacious in the treatment of phantom limb pain. Furthermore, VR has untapped potential as a cost-effective tool for microsurgical education and for training residents on techniques in surgical and nonsurgical aesthetic treatment. There is utility for mixed reality in breast reconstruction for preoperative planning, mapping perforators, and decreasing operative time. VR has well- documented applications in the planning of deep inferior epigastric perforator flaps by creating three-dimensional immersive simulations based on a patient's preoperative computed tomography angiogram.

CONCLUSION

 The benefits of AR and VR are numerous for both patients and surgeons. VR has been shown to increase surgical precision and decrease operative time. Furthermore, it is effective for patient-specific rehearsal which uses the patient's exact anatomical data to rehearse the procedure before performing it on the actual patient. Taken together, AR/VR technology can improve patient outcomes, decrease operative times, and lower the burden of care on both patients and health care institutions.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review

OBJECTIVES

Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS).

DATA SOURCES

PubMed and Web of Science.

REVIEW METHODS

According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS.

RESULTS

Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma.

CONCLUSION

AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:2568-2577, 2024.

Comparing Graduating Plastic Surgery Residents' Case Logs With Accreditation Council for Graduate Medical Education Requirements, Content at National Meetings, and In-Service Examination Test Items

BACKGROUND

The importance of adaptable and up-to-date plastic surgery graduate medical education (GME) has taken on new meaning amidst accelerating surgical innovation and increasing calls for competency-based training standards. We aimed to examine the extent to which the procedures plastic surgery residents perform, as represented in case log data, align with 2 core standardized components of plastic surgery GME: ACGME (Accreditation Council for Graduate Medical Education) minimum procedure count requirements and the PSITE (Plastic Surgery In-Service Training Examination). We also examined their alignment with procedural representation at 2 major plastic surgery meetings.

METHODS

Nine categories of reconstructive and aesthetic procedures were identified. Three-year averages for the number of procedures completed in each category by residents graduating in 2019-2021 were calculated from ACGME national case log data reports. The ACGME procedure count minimum requirements were also ascertained. The titles and durations of medical programming sessions scheduled for Plastic Surgery The Meeting (PSTM) 2022 and the Plastic Surgery Research Council (PSRC) Annual Meeting 2022 were retrieved from online data. Finally, test items from the 2020 to 2022 administrations of the PSITE were retrieved. Conference sessions and test items were assigned to a single procedure category when possible. Percent differences were calculated for comparison.

RESULTS

The distribution of procedures on plastic surgery resident case logs differs from those of the major mechanisms of standardization in plastic surgery GME, in-service examination content more so than ACGME requirements. Meeting content at PSTM and PSRC had the largest percent differences with case log data, with PSTM being skewed toward aesthetics and PSRC toward reconstructive head and neck surgery.

DISCUSSION

The criteria and standards by which plastic surgery residents are evaluated and content at national meetings differ from the procedures they actually complete during their training. Although largely reflecting heterogeneity of the specialty, following these comparisons will likely prove useful in the continual evaluation of plastic surgery residency training, especially in the preparation of residents for the variety of training and practice settings they pursue.

Spatial Fidelity of Microvascular Perforating Vessels as Perceived by Augmented Reality Virtual Projections

BACKGROUND

Autologous breast reconstruction yields improved long-term aesthetic results but requires increased resources of practitioners and hospital systems. Innovations in radiographic imaging have been increasingly used to improve the efficiency and success of free flap harvest. Augmented reality affords the opportunity to superimpose relevant imaging on a surgeon's native field of view, potentially facilitating dissection of anatomically variable structures. To validate the spatial fidelity of augmented reality projections of deep inferior epigastric perforator flap-relevant anatomy, comparisons of three-dimensional (3D) models and their virtual renderings were performed by four independent observers. Measured discrepancies between the real and holographic models were evaluated.

METHODS

The 3D-printed models of deep inferior epigastric perforator flap-relevant anatomy were fabricated from computed tomographic angiography data from 19 de-identified patients. The corresponding computed tomographic angiography data were similarly formatted for the Microsoft HoloLens to generate corresponding projections. Anatomic points were initially measured on 3D models, after which the corresponding points were measured on the HoloLens projections from two separate vantage points (V1 and V2). Statistical analyses, including generalized linear modeling, were performed to characterize spatial fidelity regarding translation, rotation, and scale of holographic projections.

RESULTS

Among all participants, the median translational displacement at corresponding points was 9.0 mm between the real-3D model and V1, 12.1 mm between the 3D model and V2, and 13.5 mm between V1 and V2.

CONCLUSION

Corresponding points, including topography of perforating vessels, for the purposes of breast reconstruction can be identified within millimeters, but there remain multiple independent contributors of error, most notably the participant and location at which the projection is perceived.

Effectiveness of immersive virtual reality in orthognathic surgical education: A randomized controlled trial

PURPOSE

To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students.

METHODS

This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self-developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40-min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect.

RESULTS

The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups.

CONCLUSIONS

The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method.

Mixed-reality technology for clinical communication: objective assessment of the HoloLens 2 as a clinical communication device in a simulated on-call scenario

OBJECTIVE

Specialty on-call clinicians cover large areas and complex workloads. This study aimed to assess clinical communication using the mixed-reality HoloLens 2 device within a simulated on-call scenario.

METHOD

This study was structured as a randomised, within-participant, controlled study. Thirty ENT trainees used either the HoloLens 2 or a traditional telephone to communicate a clinical case to a consultant. The quality of the clinical communication was scored objectively and subjectively.

RESULTS

Clinical communication using the HoloLens 2 scored statistically higher than telephone (n = 30) (11.9 of 15 vs 10.2 of 15; p = 0.001). Subjectively, consultants judged more communication episodes to be inadequate when using the telephone (7 of 30) versus the HoloLens 2 (0 of 30) (p = 0.01). Qualitative feedback indicates that the HoloLens 2 was easy to use and would add value during an on-call scenario with remote consultant supervision.

CONCLUSION

This study demonstrated the benefit that mixed-reality devices, such as the HoloLens 2 can bring to clinical communication through increasing the accuracy of communication and confidence of the users.

The application of augmented reality in plastic surgery training and education: A narrative review

Continuing problems with fewer training opportunities and a greater awareness of patient safety have led to a constant search for an alternative technique to bridge the existing theory-practice gap in plastic surgery training and education. The current COVID-19 epidemic has aggravated the situation, making it urgent to implement breakthrough technological initiatives currently underway to improve surgical education. The cutting edge of technological development, augmented reality (AR), has already been applied in numerous facets of plastic surgery training, and it is capable of realizing the aims of education and training in this field. In this article, we will take a look at some of the most important ways that AR is now being used in plastic surgery education and training, as well as offer an exciting glimpse into the potential future of this field thanks to technological advancements.

Virtual Reality and Augmented Reality in Plastic and Craniomaxillofacial Surgery: A Scoping Review

Virtual reality (VR) and augmented reality (AR) have evolved since their introduction to medicine in the 1990s. More powerful software, the miniaturization of hardware, and greater accessibility and affordability enabled novel applications of such virtual tools in surgical practice. This scoping review aims to conduct a comprehensive analysis of the literature by including all articles between 2018 and 2021 pertaining to VR and AR and their use by plastic and craniofacial surgeons in a clinician-as-user, patient-specific manner. From the initial 1637 articles, 10 were eligible for final review. These discussed a variety of clinical applications: perforator flaps reconstruction, mastectomy reconstruction, lymphovenous anastomosis, metopic craniosynostosis, dermal filler injection, auricular reconstruction, facial vascularized composite allotransplantation, and facial artery mapping. More than half (60%) involved VR/AR use intraoperatively with the remainder (40%) examining preoperative use. The hardware used predominantly comprised HoloLens (40%) and smartphones (40%). In total, 9/10 Studies utilized an AR platform. This review found consensus that VR/AR in plastic and craniomaxillofacial surgery has been used to enhance surgeons' knowledge of patient-specific anatomy and potentially facilitated decreased intraoperative time via preoperative planning. However, further outcome-focused research is required to better establish the usability of this technology in everyday practice.

A virtual surgical prototype system based on gesture recognition for virtual surgical training in maxillofacial surgery

Background

Virtual reality (VR) technology is an ideal alternative of operation training and surgical teaching. However, virtual surgery is usually carried out using the mouse or data gloves, which affects the authenticity of virtual operation. A virtual surgery system with gesture recognition and real-time image feedback was explored to realize more authentic immersion.

Method

Gesture recognition technology proposed with an efficient and real-time algorithm and high fidelity was explored. The recognition of hand contour, palm and fingertip was firstly realized by hand data extraction. Then, an Support Vector Machine classifier was utilized to classify and recognize common gestures after extraction of feature recognition. The algorithm of collision detection adopted Axis Aligned Bounding Box binary tree to build hand and scalpel collision models. What’s more, nominal radius theorem (NRT) and separating axis theorem (SAT) were applied for speeding up collision detection. Based on the maxillofacial virtual surgical system we proposed before, the feasibility of integration of the above technologies in this prototype system was evaluated.

Results

Ten kinds of signal static gestures were designed to test gesture recognition algorithms. The accuracy of gestures recognition is more than 80%, some of which were over 90%. The generation speed of collision detection model met the software requirements with the method of NRT and SAT. The response time of gesture] recognition was less than 40 ms, namely the speed of hand gesture recognition system was greater than 25 Hz. On the condition of integration of hand gesture recognition, typical virtual surgical procedures including grabbing a scalpel, puncture site selection, virtual puncture operation and incision were carried out with realization of real-time image feedback.

Conclusion

Based on the previous maxillofacial virtual surgical system that consisted of VR, triangular mesh collision detection and maxillofacial biomechanical model construction, the integration of hand gesture recognition was a feasible method to improve the interactivity and immersion of virtual surgical operation training.

The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique

Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland-Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation.

Virtual, Augmented, and Alternate Reality in Medical Education: Socially Distanced but Fully Immersed

BACKGROUND

Advancements in technology continue to transform the landscape of medical education. The need for technology-enhanced distance learning has been further accelerated by the coronavirus disease (COVID-19) pandemic. The relatively recent emergence of virtual reality (VR), augmented reality (AR), and alternate reality has expanded the possible applications of simulation-based education (SBE) outside of the traditional simulation laboratory, making SBE accessible asynchronously and in geographically diverse locations.

OBJECTIVE

In this review, we will explore the evidence base for use of emerging technologies in SBE as well as the strengths and limitations of each modality in a variety of settings.

METHODS

PubMed was searched for peer-reviewed articles published between 1995 and 2021 that focused on VR in medical education. The search terms included medical education, VR, simulation, AR, and alternate reality. We also searched reference lists from selected articles to identify additional relevant studies.

RESULTS

VR simulations have been used successfully in resuscitation, communication, and bronchoscopy training. In contrast, AR has demonstrated utility in teaching anatomical correlates with the use of diagnostic imaging, such as point-of-care ultrasound. Alternate reality has been used as a tool for developing clinical reasoning skills, longitudinal patient panel management, and crisis resource management via multiplayer platforms.

CONCLUSION

Although each of these modalities has a variety of educational applications in health profession education, there are benefits and limitations to each that are important to recognize prior to the design and implementation of educational content, including differences in equipment requirements, cost, and scalability.

Utility of Augmented Reality and Virtual Reality in Spine Surgery: A Systematic Review of the Literature

BACKGROUND

Augmented reality, virtual reality, and mixed reality (AR, VR, MR) are emerging technologies that are starting to be translated into clinical practice. There is limited data available about these tools being used in live surgery of the spine. The objective of this paper was to systematically collect, analyze, and interpret the existing data regarding AR, VR, and MR use in spine surgery on live people.

METHODS

A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). PubMed, PubMed Central, Cochrane Reviews, and Embase databases were searched. Combinations and variations of "augmented reality", "virtual reality", and "spine surgery" in both AND and OR configurations were used to gather relevant articles. References of included articles from the systematic review were also screened for possible inclusion as a part of manual review. Included studies were full text publications written in English that had any spine surgery on live persons with the use of virtual or augmented reality.

RESULTS

A total of 1566 unique articles were found, and fifteen full-text publications met criteria for this study. The total number of patients from all studies was 241 with a weighted average age of 50.37. Surgical procedures utilizing AR, VR, and/or MR were diverse and spanned from simple discectomies to intradural spinal tumor resection. All patients experienced improvement in their symptoms from clinical presentation. The highest complication rate mentioned in the articles was 6.1% and was for suboptimal pedicle screw placement. There were no complications that led to clinical sequelae.

CONCLUSIONS

The systematically collected, analyzed, and interpreted data of existing peer-reviewed full text articles showed favorable metrics regarding surgical efficacy, pedicle screw target accuracy, radiation exposure, clinical outcome, and disability and pain in patients with spinal pathology treated with the help of AR, VR, and/or MR.