Presentation Authors: Hasaneen Al Janabi*, Abdullatif Aydin, Sharanya Palaneer, London, United Kingdom, Nicola Macchione, Milan, Italy, Ahmed Al-Jabir, Muhammad Shamim Khan, Prokar Dasgupta, Kamran Ahmed, London, United Kingdom
Introduction: The advent of Augmented Reality technologies presents opportunities for enhancing traditional surgical practice. Current techniques in endoscopic surgery are prone to disturbance of a surgeonâ€™s visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The MicrosoftÂ® HoloLens is a novel head-mounted display that has not been thoroughly explored within surgical innovation research. The primary aim of this study was to assess the effectiveness of the HoloLens as an endoscopic monitor during minimally invasive surgery. The HoloLens was defined effective if the performance-related outcomes were equally as good, if not better than the outcomes with a conventional monitor.
Methods: A total of 72 participants of varying expertise in urology were recruited; novices (n=28), intermediates (n=24) and experts (n=20). Participants performed semi-rigid ureteroscopy on a validated urological simulator using both the HoloLens and conventional monitors, within an inflatable operating room environment. Primary outcomes were procedural completion time and a performance evaluation score (OSATS). A final evaluation survey assessing usability, practicality and other factors was distributed and completed for analysis.
Results: The HoloLens facilitated improved outcomes for procedural times (absolute difference, -73 seconds; 95% CI, -115 to -30; P=0.0011) and GRS scores (absolute difference, 4.1 points; 95% CI, 2.9 to 5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated that none of the participants experienced any moderate or severe headache, dizziness, nausea, eye fatigue or neck strain whilst using the HoloLens. Overall, 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% confidence interval, 4.5 to 4.8) and that it is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% confidence interval, 4.2 to 4.5).
Conclusions: This study demonstrates that the device facilitated improved outcomes of performance and was widely accepted as a surgical visual aid. The HoloLens represents a feasible and ergonomically advantageous alternative to conventional monitors, by aligning the surgeonâ€™s visual-motor axis. Further evaluation in the clinical setting is underway.
Source of Funding: Malcolm Coptcoat Trust grant