Effectiveness of the HoloLens mixed-reality headset in minimally invasive surgery: a simulation-based feasibility study

• DOI: 10.1007/s00464-019-06862-3
• Publication Date: 2019-06-18T16:04:46Z
• Authors: Hasaneen Fathy Al...; Abdullatif Aydin; Sharanya Palaneer; Nicola Macchione; Ahmed Al-Jabir; Muhammad Shamim Khan; Prokar Dasgupta; Kamran Ahmed
• Keywords: Virtual Reality; 610; Endoscopy; Augmented reality; 16. Peace & justice; Virtual reality; Article; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Head-mounted displays; HoloLens; Ureteroscopy; Feasibility Studies; Humans; Minimally Invasive Surgical Procedures; Surgery; Ergonomics; Prospective Studies

The advent of Virtual Reality technologies presents new opportunities for enhancing current surgical practice. Studies suggest that current techniques in endoscopic surgery are prone to disturbance of a surgeon's visual-motor axis, influencing performance, ergonomics and iatrogenic injury rates. The Microsoft® HoloLens is a novel head-mounted display that has not been explored within surgical innovation research. This study aims to evaluate the HoloLens as a potential alternative to conventional monitors in endoscopic surgery.This prospective, observational and comparative study recruited 72 participants consisting of novices (n = 28), intermediate-level (n = 24) and experts (n = 20). Participants performed ureteroscopy, within an inflatable operating environment, using a validated training model and the HoloLens mixed-reality device as a monitor. Novices also completed the assigned task using conventional monitors; whilst the experienced groups did not, due to their extensive familiarity. Outcome measures were procedural completion time and performance evaluation (OSATS) score. A final evaluation survey was distributed amongst all participants.The HoloLens facilitated improved outcomes for procedural times (absolute difference, - 73 s; 95% CI - 115 to - 30; P = 0.0011) and OSAT scores (absolute difference, 4.1 points; 95% CI 2.9-5.3; P < 0.0001) compared to conventional monitors. Feedback evaluation demonstrated 97% of participants agreed or strongly agreed that the HoloLens will have a role in surgical education (mean rating, 4.6 of 5; 95% CI 4.5-4.8). Furthermore, 95% of participants agreed or strongly agreed that the HoloLens is feasible to introduce clinically and will have a role within surgery (mean rating, 4.4 of 5; 95% CI 4.2-4.5).This study demonstrates that the device facilitated improved outcomes of performance in novices and was widely accepted as a surgical visual aid by all groups. The HoloLens represents a feasible alternative to the conventional setup, possibly by aligning the surgeon's visual-motor axis.