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New augmented reality remote for virtual guidance and education of fracture surgery: a retrospective, non-inferiority, multicenter cohort study

医学 回顾性队列研究 普通外科 多中心研究 队列 增强现实 队列研究 外科 人工智能 随机对照试验 内科学 计算机科学
作者
Songxiang Liu,Mao Xie,Fei Gao,Ying Fang,Mingdi Xue,Bing-Ran Zuo,Junwen Wang,Jialang Hu,Rong Liu,Jiayao Zhang,Tongtong Huo,Pengran Liu,Cheng Zeng,Andy Khye Soon Yew,Heng‐Gui Chen,Zhewei Ye
出处
期刊:International Journal of Surgery [Wolters Kluwer]
卷期号:110 (9): 5334-5341
标识
DOI:10.1097/js9.0000000000001662
摘要

Background: The demand for telesurgery is rapidly increasing. Augmented reality (AR) remote surgery is a promising alternative, fulfilling a worldwide need in fracture surgery. However, previous AR endoscopic and Google Glass remotes remain unsuitable for fracture surgery, and the application of remote fracture surgery has not been reported. The authors aimed to evaluate the safety and clinical effectiveness of a new AR remote in fracture surgery. Materials and methods: This retrospective non-inferiority cohort study was conducted at three centres. Between 1 January 2018 and 31 March 2022, 800 patients who underwent fracture surgery were eligible for participation. The study enroled 551 patients with fractures (132 patellae, 128 elbows, 126 tibial plateaus, and 165 ankles) divided into an AR group (specialists used AR to remotely guide junior doctors to perform surgeries) and a traditional non-remote group (specialists performed the surgery themselves). Results: Among 364 patients (182 per group) matched by propensity score, seven (3.8%) in the AR group and six (3%) in the non-remote group developed complications. The 0.005 risk difference (95% CI: −0.033 to 0.044) was below the pre-defined non-inferiority margin of a 10% absolute increase. A similar distribution in the individual components of all complications was found between the groups. Hierarchical analysis following propensity score matching revealed no statistical difference between the two groups regarding functional results at 1-year follow-up, operative time, amount of bleeding, number of fluoroscopies, and injury surgery interval. A Likert scale questionnaire showed positive results (median scores: 4–5) for safety, efficiency, and education. Conclusion: This study is the first to report that AR remote surgery can be as safe and effective as that performed by a specialist in person for fracture surgery, even without the physical presence of a specialist, and is associated with improving the skills and increasing the confidence of junior surgeons. This technique is promising for remote fracture surgery and other open surgeries, offering a new strategy to address inadequate medical care in remote areas.
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