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.

Extended reality as a training method for medical first responders in mass casualty incidents: A protocol for a systematic review.

INTRODUCTION/BACKGROUND: Mass-casualty incidents (MCIs) and disasters require an organised and effective response from medical first responders (MFRs). As such, novel training methods have emerged to prepare and adequately train MFRs for these challenging situations. Particular focus should be placed on extended reality (XR), which encompasses virtual, augmented and mixed reality (VR, AR, and MR, respectively), and allows participants to develop high-quality skills in realistic and immersive environments. Given the rapid evolution of high-fidelity simulation technology and its advantages, XR simulation has become a promising tool for emergency medicine. Accordingly, this systematic review aims to: 1) evaluate the effectiveness of XR training methods and 2) explore the experience of MFRs undergoing such training. METHODS: A comprehensive search strategy will encompass four distinct themes: MFRs, disasters/MCIs, education and simulation, and XR. Four databases (MEDLINE, EMBASE, CINAHL and LILACs) will be searched along with an in-depth examination of the grey literature and reference lists of relevant articles. MetaQAT will be used as a study quality assessment tool and integrated into Covidence as part of the data extraction form. Given the predicted high heterogeneity between studies, it may not be possible to standardise data for quantitative comparison and meta-analysis. Thus, data will be synthesised in a narrative, semi-quantitative manner. DISCUSSION: This review will examine the existing literature on the effectiveness of XR simulation as a tool to train MFRs for MCIs, which could ultimately improve preparedness and response to disasters. TRIAL REGISTRATION: Protocol registration: PROSPERO CRD42021275692.

Live Virtual Surgery and Virtual Reality in Surgery: Potential Applications in Hand Surgery Education.

Accelerated in part by the coronavirus disease 2019 pandemic, medical education has increasingly moved into the virtual sphere in recent years. Virtual surgical education encompasses several domains, including live virtual surgery and virtual and augmented reality. These technologies range in complexity from streaming audio and video of surgeries in real-time to fully immersive virtual simulations of surgery. This article reviews the current use of virtual surgical education and its possible applications in hand surgery. Applications of virtual technologies for preoperative planning and intraoperative guidance, as well as care in underresourced settings, are discussed. The authors describe their experience creating a virtual surgery subinternship with live virtual surgeries. There are many roles virtual technology can have in surgery, and this review explores potential value these technologies may have in hand surgery.

Fighting Pandemics With Augmented Reality and Smart Sensing-Based Social Distancing.

In a postpandemic world, remaining vigilant and maintaining social distancing are still crucial so societies can contain the virus and the public can avoid disproportionate health impacts. Augmented reality (AR) can visually assist users in understanding the distances in social distancing. However, integrating external sensing and analysis is required for social distancing beyond the users' local environment. We present DistAR, an android-based application for social distancing leveraging AR and smart sensing using on-device analysis of optical images and environment crowdedness from smart campus data. Our prototype is one of the first efforts to combine AR and smart sensing technologies to create a real-time social distancing application.

The impact of extended reality on surgery: a scoping review.

PURPOSE: Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS: A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS: One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION: The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.

Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects.

In the world reference context, although virtual reality, augmented reality and mixed reality have been emerging methodologies for several years, only today technological and scientific advances have made them suitable to revolutionize clinical care and medical contexts through the provision of enhanced functionalities and improved health services. This systematic review provides the state-of-the-art applications of the Microsoft® HoloLens 2 in a medical and healthcare context. Focusing on the potential that this technology has in providing digitally supported clinical care, also but not only in relation to the COVID-19 pandemic, studies that proved the applicability and feasibility of HoloLens 2 in a medical and healthcare scenario were considered. The review presents a thorough examination of the different studies conducted since 2019, focusing on HoloLens 2 medical sub-field applications, device functionalities provided to users, software/platform/framework used, as well as the study validation. The results provided in this paper could highlight the potential and limitations of the HoloLens 2-based innovative solutions and bring focus to emerging research topics, such as telemedicine, remote control and motor rehabilitation.

Facilitators and barriers to using virtual reality and augmented reality and its impact on social engagement in aged care settings: a scoping review protocol.

INTRODUCTION: Increasingly more studies are being conducted on the use of virtual reality (VR) and augmented reality (AR) in aged care settings. These technologies can decrease experiences of loneliness which is especially important during the COVID-19 pandemic. With the growing interest in using VR/AR in care settings among older adults, a comprehensive review of studies examining the facilitators and barriers of adopting VR/AR in these settings is needed. This scoping review will focus on facilitators and barriers related to VR/AR in care settings among older adults, as well as the impact on social engagement and/or loneliness. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute scoping review methodology. We will search the following databases: CINHAL, Embase, Medline, PsycINFO, Scopus and Web of Science. Additional articles will be handpicked from reference lists of included articles. Inclusion criteria includes articles that focus on older adults using VR or AR in aged care settings. Our team (which includes patient and family partners, an academic nurse researcher, a clinical lead and trainees) will be involved in the search, review and analysis process. ETHICS AND DISSEMINATION: We will be collecting data from publicly available articles for this scoping review, so ethics approval is not required. By providing a comprehensive overview of the current evidence on the strategies, facilitators, and barriers of using VR/AR in aged care settings, findings will offer insights and recommendations for future research and practice to better implement VR/AR. The results of this scoping review will be shared through conference presentations and an open-access publication in a peer-reviewed journal.

Stone disease in low- and middle-income countries: could augmented reality have a role in its management?

Urolithiasis is a global phenomenon. Cystolithiasis is common in parts of Africa due to low protein intake and dehydration from endemic diarrhoeal illnesses. Nephrolithiasis is less prevalent than in high-income countries, probably due to a variety of lifestyle issues, such as a more elemental diet, higher physical activity, and less obesity. Although renal stones are less common in low- and middle-income countries (LMICs), the social and economic impacts of nephrolithiasis are still considerable; many stones present late or with complications such as upper urinary tract obstruction or urosepsis. These may lead to the development of chronic kidney disease, or end-stage renal failure in a small proportion of cases, conditions for which there is very poor provision in most LMICs. Early treatment of nephrolithiasis by the least invasive method possible can, however, reduce the functional consequences of urinary stone disease. Although extracorporeal lithotripsy is uncommon, and endoscopic interventions for stone are not widespread in most of Africa, percutaneous nephrolithotomy and ureteroscopic renal surgery are viable techniques in those regional centres with infrastructure to support them. Longitudinal mentoring has been shown to be a key step in the adoption of these minimally invasive procedures by local surgeons, something that has been difficult during the coronavirus disease 2019 (COVID-19) pandemic due to travel restriction. Augmented reality (AR) technology is an alternative means of providing remote mentoring, something that has been trialled by Urolink, the MediTech Trust and other global non-governmental organisations during this period. Our preliminary experience suggests that this is a viable technique for promulgating skills in LMICs where appropriate connectivity exists to support remote communication. AR may also have long-term promise for decreasing the reliance upon short-term surgical visits to consolidate competence, thereby reducing the carbon footprint of global surgical education.

Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial.

The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18-35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.

Augmented reality for teaching anatomy.

Successive waves of the coronavirus (COVID-19) pandemic lockdowns resulted in significant reduction in face-to-face teaching, with an adverse effect especially on sectors requiring direct skill acquisition. Despite the fact that augmented reality (AR) presents an equitable, cost-effective solution which reduces crowding in the confined spaces of the dissection theater, the benefits of AR-supported undergraduate medical education have been poorly investigated. We conducted a validated survey to explore the value of AR in the dissection theater and assess its impact from the learner's perspective. Further to a validated pilot (n = 30), a larger scale study (n = 130) was conducted to assess the introduction of AR across three different learning domains: retaining anatomy detail, perception of spatial anatomical relations, and speed of learning. A response rate of 85.4% was reported. Our results suggest that the use of AR technology leads to a significant enhancement of spatial relations, faster detailed material assimilation and assistance in understanding of key concepts. In addition, most participants opt to recommend AR as a valuable tool in the learning process. In view of the proposed added value of AR technology in various teaching aspects, we recommend that AR should be introduced as a standard practice in both pre- and postgraduate medical curricula and suggest further research regarding the use of this technology.

Digital Transformation Will Change Medical Education and Rehabilitation in Spine Surgery.

The concept of minimally invasive spine therapy (MIST) has been proposed as a treatment strategy to reduce the need for overall patient care, including not only minimally invasive spine surgery (MISS) but also conservative treatment and rehabilitation. To maximize the effectiveness of patient care in spine surgery, the educational needs of medical students, residents, and patient rehabilitation can be enhanced by digital transformation (DX), including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR), three-dimensional (3D) medical images and holograms; wearable sensors, high-performance video cameras, fifth-generation wireless system (5G) and wireless fidelity (Wi-Fi), artificial intelligence, and head-mounted displays (HMDs). Furthermore, to comply with the guidelines for social distancing due to the unexpected COVID-19 pandemic, the use of DX to maintain healthcare and education is becoming more innovative than ever before. In medical education, with the evolution of science and technology, it has become mandatory to provide a highly interactive educational environment and experience using DX technology for residents and medical students, known as digital natives. This study describes an approach to pre- and intraoperative medical education and postoperative rehabilitation using DX in the field of spine surgery that was implemented during the COVID-19 pandemic and will be utilized thereafter.

Assessing acceptance of augmented reality in nursing education.

The Covid-19 pandemic has negatively affected every aspect of human life. In these challenging times nursing students, facing academic and psychological issues, are advised to use augmented reality applications in the field of health sciences for increasing their motivations and academic performances. The main motive of the study was to examine the acceptance status of nursing students in implementing augmented reality technology in their education and training. The study is a quantitative research study, and it uses the causal-comparative screening method. The data used in the study was collected online from 419 nursing students. The hybrid method was preferred. First, the hypotheses based on the linear relationships were defined between the variables which were then tested by the method of structural equation modeling. Second, the method of artificial neural networks was used to determine the non-linear relationships between the variables. The results show that the nursing students have a high intention of using augmented reality technology as a way of self-learning. It was also found that the most emphasized motive behind this intention is the expectation that using augmented reality technology will increase their academic performance. They also think that AR technology has many potential benefits to offer in the future. It was observed that a considerable number of students already use augmented reality technology for its usefulness and with a hedonic motivation. In conclusion, nursing students have a high acceptance of using augmented reality technology during their education and training process. Since we live in a world where e-learning and self-learning education/training have become widespread, it is estimated that students will demand augmented reality applications as a part of holistic education, and as an alternative to traditional textbooks.

My Caregiver the Cobot: Comparing Visualization Techniques to Effectively Communicate Cobot Perception to People with Physical Impairments.

Nowadays, robots are found in a growing number of areas where they collaborate closely with humans. Enabled by lightweight materials and safety sensors, these cobots are gaining increasing popularity in domestic care, where they support people with physical impairments in their everyday lives. However, when cobots perform actions autonomously, it remains challenging for human collaborators to understand and predict their behavior, which is crucial for achieving trust and user acceptance. One significant aspect of predicting cobot behavior is understanding their perception and comprehending how they "see" the world. To tackle this challenge, we compared three different visualization techniques for Spatial Augmented Reality. All of these communicate cobot perception by visually indicating which objects in the cobot's surrounding have been identified by their sensors. We compared the well-established visualizations Wedge and Halo against our proposed visualization Line in a remote user experiment with participants suffering from physical impairments. In a second remote experiment, we validated these findings with a broader non-specific user base. Our findings show that Line, a lower complexity visualization, results in significantly faster reaction times compared to Halo, and lower task load compared to both Wedge and Halo. Overall, users prefer Line as a more straightforward visualization. In Spatial Augmented Reality, with its known disadvantage of limited projection area size, established off-screen visualizations are not effective in communicating cobot perception and Line presents an easy-to-understand alternative.

Mixed Reality-Based Interaction between Human and Virtual Cat for Mental Stress Management.

Human-animal interaction (HAI) has been observed to effectively reduce stress and induce positive emotions owing to the process of directly petting and interacting with animals. Interaction with virtual animals has recently emerged as an alternative due to the limitations in general physical interactions, both due to the COVID-19 pandemic and, more generally, due to the difficulties involved in providing adequate care for animals. This study proposes mixed reality (MR)-based human-animal interaction content along with presenting the experimental verification of its effect on the reduction of mental stress. A mental arithmetic task was employed to induce acute mental stress, which was followed by either MR content, in which a participant interacted with virtual animals via gestures and voice commands, or a slide show of animal images. During the experiment, an electrocardiogram (ECG) was continuously recorded with a patch-type, wireless ECG sensor on the chest of the subject, and their psychological state was evaluated with the help of questionnaires after each task. The findings of the study demonstrate that the MR-based interaction with virtual animals significantly reduces mental stress and induces positive emotions. We expect that this study could provide a basis for the widespread use of MR-based content in the field of mental health.

HoloMentor: A Novel Mixed Reality Surgical Anatomy Curriculum for Robot-Assisted Radical Prostatectomy.

OBJECTIVES: The disruption to surgical training and medical education caused by the global COVID-19 pandemic highlighted the need for realistic, reliable, and engaging educational opportunities available outside of the operating theatre and accessible for trainees of all levels. This article presents the design and development of a virtual reality curriculum which simulates the surgical mentorship experience outside of the operating theatre, with a focus on surgical anatomy and surgical decision-making. METHOD: This was a multi-institutional study between London's King's College and Imperial College. The index procedure selected for the module was robotic radical prostatectomy. For each stage of the surgical procedure, subject-matter experts (N = 3) at King's College London, identified (1) the critical surgical-decision making points, (2) critical anatomical landmarks, and (3) tips and techniques for overcoming intraoperative challenges. Content validity was determined by an independent panel of subject-matter experts (N = 8) at Imperial College, London, using Fleiss' kappa statistic. The experts' teaching points were combined with operative footage and illustrative animations, and projected onto a virtual reality headset. The module was piloted to surgical science students (N = 15). Quantitative analysis compared participants' confidence regarding their anatomical knowledge before and after taking the module. Qualitative data were gathered from students regarding their views on using the virtual reality model. RESULTS: Multi-rater agreement between experts was above the 70.0% threshold for all steps of the procedure. Seventy-three percentage of pilot study participants "agreed" or "strongly agreed" that they achieved a better understanding of surgical anatomy and the rationale behind each procedural step. This was reflected in an increase in the median knowledge score after trialing the curriculum (p < 0.001). 100% of subject-matter experts and 93.3% of participants "agreed" or "strongly agreed" that virtual mentorship would be useful for future surgical training. CONCLUSIONS: This study demonstrated that virtual surgical mentorship could be a feasible and cost-effective alternative to traditional training methods with the potential to improve technical skills, such as operative proficiency and nontechnical skills such as decision-making and situational judgement.

Remote mentoring in laparotomic and laparoscopic cancer surgery during Covid-19 pandemic: an experimental setup based on mixed reality.

In this paper, Mixed Reality (MR) has been exploited in the operating rooms to perform laparoscopic and open surgery with the aim of providing remote mentoring to the medical doctors under training during the Covid-19 pandemic. The employed architecture, which has put together MR smartglasses, a Digital Imaging Player, and a Mixed Reality Toolkit, has been used for cancer surgery at the IRCCS Hospital 'Giovanni Paolo II' in southern Italy. The feasibility of using the conceived platform for real-time remote mentoring has been assessed on the basis of surveys distributed to the trainees after each surgery.