scholarly journals Towards a First-Person Perspective Mixed Reality Guidance System for Needle Interventions

2022 ◽  
Vol 8 (1) ◽  
pp. 7
Author(s):  
Leah Groves ◽  
Natalie Li ◽  
Terry M. Peters ◽  
Elvis C. S. Chen
Keyword(s):  
Medical Students ◽  
User Study ◽  
Mixed Reality ◽  
Surgical Navigation ◽  
Guidance System ◽  
Complication Rates ◽  
Success Rates ◽  
Head Mounted Display ◽  
Us Guidance ◽  
Significant Difference

While ultrasound (US) guidance has been used during central venous catheterization to reduce complications, including the puncturing of arteries, the rate of such problems remains non-negligible. To further reduce complication rates, mixed-reality systems have been proposed as part of the user interface for such procedures. We demonstrate the use of a surgical navigation system that renders a calibrated US image, and the needle and its trajectory, in a common frame of reference. We compare the effectiveness of this system, whereby images are rendered on a planar monitor and within a head-mounted display (HMD), to the standard-of-care US-only approach, via a phantom-based user study that recruited 31 expert clinicians and 20 medical students. These users performed needle-insertions into a phantom under the three modes of visualization. The success rates were significantly improved under HMD-guidance as compared to US-guidance, for both expert clinicians (94% vs. 70%) and medical students (70% vs. 25%). Users more consistently positioned their needle closer to the center of the vessel’s lumen under HMD-guidance compared to US-guidance. The performance of the clinicians when interacting with this monitor system was comparable to using US-only guidance, with no significant difference being observed across any metrics. The results suggest that the use of an HMD to align the clinician’s visual and motor fields promotes successful needle guidance, highlighting the importance of continued HMD-guidance research.

scholarly journals Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

2020 ◽  
pp. flgastro-2019-101380
Author(s):  
Jared Rejeski ◽  
Marc Hines ◽  
Jason Jones ◽  
Jason Conway ◽  
Girish Mishra ◽  
...  
Keyword(s):  
High Volume ◽  
Complication Rates ◽  
Success Rates ◽  
Biliary Cannulation ◽  
Pancreatic Duct Stenting ◽  
Significant Difference ◽  
Effective Option ◽  
Needle Knife ◽  
Precut Sphincterotomy ◽  
Rectal Indomethacin

GoalsOur study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.BackgroundComplication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.StudyWe performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.ResultsWe identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).ConclusionThis data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

scholarly journals COMPLICATED INGUINAL HERNIAS;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Naveed Akhtar ◽  
Syed Shams- Ul-Hassan ◽  
Muhammad Sabir ◽  
M. Nauman Ashraf
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Wound Infection ◽  
P Value ◽  
Emergency Setting ◽  
Complication Rates ◽  
Success Rates ◽  
Inguinal Hernias ◽  
Significant Difference ◽  
The Mean

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

scholarly journals Evaluating Virtual Human Role-Players for the Practice and Development of Leadership Skills

2021 ◽  
Vol 2 ◽  
Author(s):  
Gonzalo Suárez ◽  
Sungchul Jung ◽  
Robert W. Lindeman
Keyword(s):  
Leadership Training ◽  
User Study ◽  
Mixed Reality ◽  
Leadership Skills ◽  
Training Session ◽  
Virtual Human ◽  
Training Experience ◽  
Significant Difference ◽  
Role Players ◽  
The Impact

This article reports on a study to evaluate the effectiveness of virtual human (VH) role-players as leadership training tools within two computer-generated environments, virtual reality (VR) and mixed reality (MR), compared to a traditional training method, real human (RH) role-players in a real-world (RW) environment. We developed an experimental training platform to assess the three conditions: RH role-players in RW (RH-RW), VH role-players in VR (VH-VR), and VH role-players in MR (VH-MR), during two practice-type opportunities, namely pre-session and post-session. We conducted a user study where 30 participants played the role of leaders in interacting with either RHs or VHs before and after receiving a leadership training session. We then investigated (1) if VH role-players were as effective as RH role-players during pre- and post-sessions, and (2) the impact that the human-type (RH, VH) in conjunction with the environment-type (RW, VR, MR) had on the outcomes. We also collected user reactions and learning data from the overall training experience. The results showed a regular increase in performance from pre- to post-sessions in all three conditions. However, we did not find a significant difference between VHs and RHs. Interestingly, the VH-MR condition had a more significant influence on performance and task engagement compared to the VH-VR and RH-RW conditions. Based on our findings, we conclude that VH role-players can be as effective as RH role-players to support the practice of leadership skills, where VH-MR could be the best method due to its effectiveness.

scholarly journals Lead extractions: dissecting adhesions up to the lead-tip of the right ventricle: safety and success-rates

2021 ◽  
Author(s):  
Olivier Witte ◽  
Peter Delnoy ◽  
Abdul Ghani ◽  
Jaap Jan Smit ◽  
Anand Ramdat Misier ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Major Complication ◽  
Complete Removal ◽  
Lead Extraction ◽  
Complication Rates ◽  
Evolution System ◽  
Success Rates ◽  
Significant Difference ◽  
Group B ◽  
The Right

Objectives and Background: Goal of Transvenous Lead Extraction (TLE) is complete removal of all targeted leads, without complications. Despite counter traction manoeuvres, efficacy rates are often hampered by broken right ventricle lead (RV-lead) tips. Mechanically powered lead extraction (Evolution sheath) is effective, however safety of dissection up to the lead tip is unclear. Therefore, we examined the feasibility and safety of RV-lead extraction requiring dissection up to the myocardium. Methods and results: From 2009 to 2018, all TLE in the Isala Heart Centre (Zwolle, The Netherlands) requiring the hand-powered mechanical Evolution system to extract RV-leads (n=185) were examined from a prospective registry. We assessed 2 groups: TLE with the first generation Evolution (n=43) with (A1,n=18) and without (A2,n=25) adhesions up to the myocardium and TLE with the Novel R/L type (n=142) of sheath with (B1,n=59) and without (B2,n=83) adhesions up to the myocardium. Complete success rate in Group B was significantly higher than group A (96.5 vs 76.7%, p=0.0354). When comparing the patients with adhesions up to the myocardium, total complete success is higher in the R/L group (61.1% vs 90.5%, p=0.0067). There were no deaths. Overall major complication rates were low (2/185;1.1%) and there was no statistically significant difference in major and minor complications between the two groups. Conclusion: Extraction strategy with the bidirectional Evolution R/L sheath for right ventricular leads with adhesions up to the myocardium is safe and feasible.

scholarly journals Mixed reality as a novel tool for diagnostic and surgical navigation in orthopaedics

2021 ◽  
Vol 16 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Andrea Teatini ◽  
Rahul P. Kumar ◽  
Ole Jakob Elle ◽  
Ola Wiig
Keyword(s):  
Mixed Reality ◽  
Surgical Navigation ◽  
Age Groups ◽  
Qualitative Assessment ◽  
Surgical Instrument ◽  
Orthopaedic Surgeons ◽  
Head Mounted Display ◽  
Navigation Tool ◽  
Surgical Tool ◽  
Instrument Tracking

Abstract Purpose This study presents a novel surgical navigation tool developed in mixed reality environment for orthopaedic surgery. Joint and skeletal deformities affect all age groups and greatly reduce the range of motion of the joints. These deformities are notoriously difficult to diagnose and to correct through surgery. Method We have developed a surgical tool which integrates surgical instrument tracking and augmented reality through a head mounted display. This allows the surgeon to visualise bones with the illusion of possessing “X-ray” vision. The studies presented below aim to assess the accuracy of the surgical navigation tool in tracking a location at the tip of the surgical instrument in holographic space. Results Results show that the average accuracy provided by the navigation tool is around 8 mm, and qualitative assessment by the orthopaedic surgeons provided positive feedback in terms of the capabilities for diagnostic use. Conclusions More improvements are necessary for the navigation tool to be accurate enough for surgical applications, however, this new tool has the potential to improve diagnostic accuracy and allow for safer and more precise surgeries, as well as provide for better learning conditions for orthopaedic surgeons in training.

scholarly journals Mixed reality for teaching catheter placement to medical students: a randomized single-blinded, prospective trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
D. S. Schoeb ◽  
J. Schwarz ◽  
S. Hein ◽  
D. Schlager ◽  
P. F. Pohlmann ◽  
...  
Keyword(s):  
Medical Students ◽  
Mixed Reality ◽  
Prospective Trial ◽  
Learning Outcome ◽  
Catheter Placement ◽  
Guidance System ◽  
Control Group ◽  
Medical Procedure ◽  
Bladder Catheter ◽  
Mr Guidance

Abstract Background Cost-effective methods to facilitate practical medical education are in high demand and the “mixed-reality” (MR) technology seems suitable to provide students with instructions when learning a new practical task. To evaluate a step-by-step mixed reality (MR) guidance system for instructing a practical medical procedure, we conducted a randomized, single-blinded prospective trial on medical students learning bladder catheter placement. Methods We enrolled 164 medical students. Students were randomized into 2 groups and received instructions on how to perform bladder catheter placement on a male catheterization training model. One group (107 students) were given their instructions by an instructor, while the other group (57 students) were instructed via an MR guidance system using a Microsoft HoloLens. Both groups did hands on training. A standardized questionnaire covering previous knowledge, interest in modern technologies and a self-evaluation was filled out. In addition, students were asked to evaluate the system’s usability. We assessed both groups’s learning outcome via a standardized OSCE (objective structured clinical examination). Results Our evaluation of the learning outcome revealed an average point value of 19.96 ± 2,42 for the control group and 21.49 ± 2.27 for the MR group - the MR group’s result was significantly better (p = 0.00). The self-evaluations revealed no difference between groups, however, the control group gave higher ratings when evaluating the quality of instructions. The MR system’s assessment showed less usability, with a cumulative SUS (system usability scale) score of 56.6 (lower half) as well as a cumulative score of 24.2 ± 7.3 (n = 52) out of 100 in the NASA task load index. Conclusions MR is a promising tool for instructing practical skills, and has the potential to enable superior learning outcomes. Advances in MR technology are necessary to improve the usability of current systems. Trial registration German Clinical Trial Register ID: DRKS00013186

scholarly journals Comparing Blind and Ultrasound-Guided Retrobulbar Nerve Blocks in Equine Cadavers: The Training Effect

Animals ◽  
2022 ◽  
Vol 12 (2) ◽  
pp. 154
Author(s):  
Hanneke Hermans ◽  
Ralph A. Lloyd-Edwards ◽  
Aukje J. H. Ferrão-van Sommeren ◽  
Anne A. Tersmette ◽  
Jacobine C. M. Schouten ◽  
...  
Keyword(s):  
Central Position ◽  
Blue Dye ◽  
Complication Rates ◽  
Nerve Blocks ◽  
Us Guidance ◽  
Needle Position ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

In standing ophthalmic surgery in horses, a retrobulbar nerve block (RNB) is often placed blindly for anesthesia and akinesia. The ultrasound (US)-guided RNB may have fewer complications, but the two techniques have only been compared once in equine cadavers. This study compares the techniques for success and complication rates and analyzes the effect of training on US guidance. Twenty-two equine cadavers were divided into three groups: blind RNBs were performed bilaterally in eight cadavers, US-guided RNBs were performed bilaterally in seven cadavers, and after US-guided training, blind RNBs were performed bilaterally in seven cadavers. All RNBs were performed by the same two inexperienced operators, and a combination of contrast medium (CM; 1.25 mL) and methylene blue dye (1.25 mL) were injected (2.5 mL total volume). Needle positioning in the periorbita and the distance of the CM to the optic foramen were assessed using computerized tomography (CT). Dye spreading was evaluated by dissection. In group 1, 37.5% of the injections were in the optimal central position in the periorbita; in group 2, 75% and in group 3, 71.4%. There was no significant difference between the groups regarding needle position (groups 1 and 2 p = 0.056; groups 1 and 3 p = 0.069, groups 2 and 3 p = 0.8). The mean CM distribution distance was not significantly different between all groups. Group 1 had 18.75% intraocular injections versus 0% in group 2 and 7.1% in group 3 (not significant). US guidance showed no significant increases in accuracy nor decreases in complications. However, the effects on accuracy showed a trend towards significant improvement, and larger scale follow-up studies might show significant training effects on US guidance.

Trabeculectomy with mitomycin C alone or coupled with intracamerular bevacizumab? A 2-year comparative study

2021 ◽  
pp. bjophthalmol-2021-319039
Author(s):  
Patrícia José ◽  
Filipa Jorge Teixeira ◽  
Rafael Barão ◽  
David Cordeiro Sousa ◽  
Raquel Esteves Marques ◽  
...  
Keyword(s):  
Comparative Study ◽  
Mitomycin C ◽  
Primary Outcome ◽  
Open Angle Glaucoma ◽  
Complication Rates ◽  
Success Rates ◽  
Surgical Success ◽  
Significant Difference ◽  
Registration Number

PurposeTo compare outcomes of primary trabeculectomy using either mitomycin C (MMC) alone versus MMC augmented with intracamerular bevacizumab in patients with open-angle glaucoma.MethodsRetrospective, cohort, two-centre, comparative study. Patients’ data were screened between October 2015 and March 2019, with inclusion requiring a minimum follow-up of 24 months. Primary outcome was intraocular pressure (IOP) lowering at 24 months, with surgical success defined with different maximum IOP targets (≤18, ≤16 and ≤14 mm Hg) and at least 30% reduction and higher than 5 mm Hg. Absolute success was achieved if no IOP-lowering medication was needed and a qualified success if otherwise. Safety outcomes were analysed.ResultsA total of 110 eyes underwent trabeculectomy with MMC, 51 of these combined with intracamerular bevacizumab. Both strategies were effective in terms of IOP lowering (baseline vs 2 years postoperatively: 24.4 (8.0) mm Hg vs 12.1 (5.3) mm Hg in the MMC group; 25.1 (8.7) vs 10.8 (3.8) mm Hg in the MMC+bevacizumab group; p<0.001 in both comparisons). The MMC+bevacizumab group had a significant difference towards higher efficacy on absolute success rates at all targets (IOP≤14 or ≤16 or ≤18 mm Hg; p=0.010, p=0.039 and p=0.007, respectively). The large majority (93%) of the MMC+bevacizumab group was drop-free at 24 months, and 41% had IOP below 10 mm Hg. Complication rates were low and similar between groups, with no systemic adverse events.ConclusionsIntracamerular bevacizumab in MMC-augmented primary trabeculectomy increases the chances of obtaining low IOP outcomes. This strategy may be useful when planning for surgeries aiming at target pressures in the low teens.Trial registration numberISRCTN93098069.

A Novel Evaluation Model for a Mixed-Reality Surgical Navigation System: Where Microsoft HoloLens Meets the Operating Room

2020 ◽  
Vol 27 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Yan Zuo ◽  
Taoran Jiang ◽  
Jiansheng Dou ◽  
Dewang Yu ◽  
Zaphlene Nyakuru Ndaro ◽  
...  
Keyword(s):  
Navigation System ◽  
Mixed Reality ◽  
Surgical Navigation ◽  
Evaluation Model ◽  
Feasibility Studies ◽  
Evaluation Study ◽  
Lessons Learned ◽  
Good Precision ◽  
Surgical Navigation System ◽  
Significant Difference

HoloLens-based mixed-reality surgical navigation system (MR-SNS) technology has made great progress. However, the methodology for evaluating users’ perceptions concerning the safety, comfort, and efficiency of MR-SNS is still in its infancy. This study was intended to develop a method to systematically evaluate an existing MR-SNS system during actual clinical applications. This method differs from other existing methods currently used in industry, education, and device maintenance. Based on analytical hierarchy process theory and ergonomics evaluation methods, in this article, we propose a novel multicriteria evaluation model for a HoloLens-based MR-SNS. The model includes factors such as comfort, safety, and effectiveness, and is performed in an actual clinical application. A comprehensive experimental platform and scoring system that can analyze all indicators was built. The validation test showed no statistically significant differences in the accuracy of the 3 different movement patterns ( P = .95, P > .05). However, the static pattern showed the best accuracy. In addition, no significant difference ( P = .68, P > .05) in accuracy was found under 4 kinds of illuminance. A comparison of the results of this evaluation model and the input from experts who use the HoloLens-based MR-SNS in hospitals, indicated that this model has good precision (100%), recall (80%), and F1-measure (88.89%). The results highlighted the full efficacy of the proposed model in determining whether this system can be used in clinical trials to provide indicators for preliminary ex ante feasibility studies. This article describes the lessons learned from conducting this evaluation study of MR-SNS as part of the design process.

Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

2020 ◽  
Vol 49 (3) ◽  
pp. E11 ◽  
Author(s):  
Yoshifumi Kudo ◽  
Ichiro Okano ◽  
Tomoaki Toyone ◽  
Akira Matsuoka ◽  
Hiroshi Maruyama ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Decompression Surgery ◽  
Complication Rates ◽  
Lumbar Interbody Fusion ◽  
Posterior Decompression ◽  
Lateral Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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