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A systematic review of virtual reality for the assessment of technical skills in neurosurgery

机译：用于评估神经外科技术技能的虚拟现实的系统评价

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OBJECTIVE Virtual reality (VR) and augmented reality (AR) systems are increasingly available to neurosurgeons. These systems may provide opportunities for technical rehearsal and assessments of surgeon performance. The assessment of neurosurgeon skill in VR and AR environments and the validity of VR and AR feedback has not been systematically reviewed. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted through MEDLINE and PubMed. Studies published in English between January 1990 and February 2021 describing the use of VR or AR to quantify surgical technical performance of neurosurgeons without the use of human raters were included. The types and categories of automated performance metrics (APMs) from each of these studies were recorded. RESULTS Thirty-three VR studies were included in the review; no AR studies met inclusion criteria. VR APMs were categorized as either distance to target, force, kinematics, time, blood loss, or volume of resection. Distance and time were the most well-studied APM domains, although all domains were effective at differentiating surgeon experience levels. Distance was successfully used to track improvements with practice. Examining volume of resection demonstrated that attending surgeons removed less simulated tumor but preserved more normal tissue than trainees. More recently, APMs have been used in machine learning algorithms to predict level of training with a high degree of accuracy. Key limitations to enhanced-reality systems include limited AR usage for automated surgical assessment and lack of external and longitudinal validation of VR systems. CONCLUSIONS VR has been used to assess surgeon performance across a wide spectrum of domains. The VR environment can be used to quantify surgeon performance, assess surgeon proficiency, and track training progression. AR systems have not yet been used to provide metrics for surgeon performance assessment despite potential for intraoperative integration. VR-based APMs may be especially useful for metrics that are difficult to assess intraoperatively, including blood loss and extent of resection.
机译：目标 虚拟现实 （VR） 和增强现实 （AR） 系统越来越多地被神经外科医生使用。这些系统可以为技术排练和评估外科医生的表现提供机会。尚未系统地评价 VR 和 AR 环境中神经外科医生技能的评估以及 VR 和 AR 反馈的有效性。方法 根据系统综述和荟萃分析的首选报告项目（PRISMA）指南，通过MEDLINE和PubMed进行系统评价。纳入了 1990 年 1 月至 2021 年 2 月期间以英文发表的研究，这些研究描述了在不使用人类评估员的情况下使用 VR 或 AR 来量化神经外科医生的手术技术表现。记录了每项研究中自动性能指标 （APM） 的类型和类别。结果 本综述共纳入33项VR研究;没有AR研究符合纳入标准。VR APM 被分类为与目标的距离、力、运动学、时间、失血量或切除量。距离和时间是研究最充分的APM领域，尽管所有领域都能有效地区分外科医生的经验水平。距离被成功地用于跟踪实践的改进。检查切除体积表明，与受训者相比，主治外科医生切除的模拟肿瘤较少，但保留了更多的正常组织。最近，APM 已被用于机器学习算法中，以高度准确地预测训练水平。增强现实系统的主要局限性包括AR在自动手术评估中的使用有限，以及缺乏对VR系统的外部和纵向验证。结论 VR 已被用于评估外科医生在广泛领域的表现。VR 环境可用于量化外科医生的表现、评估外科医生的熟练程度并跟踪培训进度。尽管AR系统具有术中整合的潜力，但尚未用于为外科医生的绩效评估提供指标。基于 VR 的 APM 对于术中难以评估的指标（包括失血量和切除范围）可能特别有用。

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