Impact of mixed reality application on the learning curve of laparoscopic nephrectomy

Abstract

Aim - to evaluate the effectiveness and safety of mixed reality (MR) in surgeon's learning curve for laparoscopic nephrectomy (LNE). Material and methods. There were 40 prospectively recruited patients that have undergone LNE; in 20 patients, the results of contrast-enhanced multislice computed tomography of the urinary system (MSCT US) were converted to MR models. The MR platform allowed surgeons to rotate and disassemble the anatomy of the kidneys during the preoperative phase, as well as directly during the surgery; patients could also see their anatomical structures while having the surgical procedure explained step-by-step. The Likert scale questionnaire allowed to assesse the understanding and usefulness of the MR model in anatomical kidney surgery. The surgeons involved in the study also commented on whether MR affected their learning curve. Surgical outcomes for the MR patient cohort were compared with a prospectively matched cohort of LNE patients without MR. Results. The mean operative time in the MR group was significantly lower than in the non-MR group (78.5 versus 95.6 min; p<0.05). The differences in the indices of intraoperative blood loss were 58 versus 150 ml (p=0.081). Postoperative complications 5 versus 15% (p=0.09) for the MR group and the non-MR group, respectively. There was no significant difference in the length of hospital stay between the 2 groups (72±4 versus 48±5 hours, p=0.01). The novice surgeon reached a plateau after 20 surgical procedures. Conclusion. The preoperative review of MR models changed the on-line approach, shortened surgery time, and improved LNE results. The implementation of mixed reality technology in the course of teaching the technique of laparoscopic nephrectomy demonstrated positive results in terms of the speed of reaching the plateau of surgical procedures without any complications. The process of preparing and using a volumetric model of an organ in the course of LNE training did not cause difficulties for specialists, and lead to an acceleration of operation in the technique training without loss of quality.