Sir:
Microsurgical proficiency and efficiency require frequent, time-intensive training to develop precise hand-eye coordination and fine motor control. Unfortunately, such training is not readily available to all trainees because of the high cost of surgical microscopes and microsurgical laboratories. Training alternatives should simulate the actual surgical experience, and also be affordable and portable enough to meet the needs of trainees. Toward this end, we have combined a virtual reality headset, a digital microscope, and computer software to build a simple platform that simulates working under a surgical microscope.
A digital microscope is connected to the computer and the microscope’s manufacturer software is used to obtain a video feed on the computer. A virtual reality headset connected to the same computer uses a virtual reality software to mirror microscope video for the user/trainee (Fig. 1). (See Video, Supplemental Digital Content 1, which demonstrates microsurgical training with a virtual reality headset and a digital microscope, available in the “Related Videos” section of the full-text article on PRSJournal.com or, for OVID users, available at https://links.lww.com/PRS/D138. See Figure, Supplemental Digital Content 2, which shows additional tools required for our virtual reality platform: (left) a Universal Serial Bus digital microscope and (right) a virtual reality headset, available at https://links.lww.com/PRS/D139.) Any practice model and microsurgical instruments can then be used. The magnification and focus of the microscope can be tailored.
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Fig. 1.: Users practicing on the chicken wing model using our training platform.
Video.: Supplemental Digital Content 1 demonstrates microsurgical training with a virtual reality headset and a digital microscope, available in the “Related Videos” section of the full-text article on PRSJournal.com or, for OVID users, available at
https://links.lww.com/PRS/D138.
A list of required tools includes a personal computer with Trinus virtual reality (Odd Sheep Limited, London, United Kingdom) installed, a virtual reality headset (PlayStation virtual reality headset; Sony, Tokyo, Japan), a Universal Serial Bus digital microscope (Koolatron, Shenzhen, People’s Republic of China), microsurgical instruments, and any practice model of choice.
Training with a virtual reality headset has the advantage of replicating the experience of looking into the binocular lens as is done with the surgical microscope. The headset also enables good posture for prolonged training. In addition, the virtual reality headset blocks distractions from the surrounding environment, allowing trainees to stay focused and efficient during training (See Video, Supplemental Digital Content 1, https://links.lww.com/PRS/D138). Moreover, the virtual reality technology may be used as a transition to simulate working under a robotic surgery console.1 (See Figure, Supplemental Digital Content 3, which shows a demonstration of vascular anastomosis with a 10-0 suture on a 2-mm vessel, available at https://links.lww.com/PRS/D140.)
A disadvantage with this platform is that it may be hard to look away from the headset to change instruments. However, this can be easily overcome by familiarization with the layout on the table. Also, because of having only one camera on the microscope, the depth perception is not ideal.
Although virtual reality has been previously implemented for microsurgical training, the platform involved two iPhones (Apple, Inc., Cupertino, Calif.) to operate,2 was considerably more expensive, and did not allow for the magnification comparable to a digital microscope. As a more accessible alternative, we use the PlayStation virtual reality headset for our platform, as this is the most affordable standalone virtual reality headset on the market at the time of writing and can deliver adequate image quality (1080 × 960 pixels per eye) for microsurgical training. Alternatively, a smartphone can be used and combined with a Google Cardboard (Google, Inc., Mountain View, Calif.) virtual reality mount (made of cardboard material that mounts a smartphone into a virtual reality headset) to further reduce the overall cost, although this may not be as comfortable as PlayStation virtual reality. A cost analysis of both options is shown in Table 1.
Table 1.: Costs of Two Different Setups Described*
We believe the combination of a virtual realty headset with a digital microscope is a compact and economical alternative for microsurgical training. However, the translatability of skills obtained by trainees with this platform to the operating room and robotic surgery will need to be evaluated in further studies.
DISCLOSURE
None of the authors received any funds related to this study. The authors have no financial interest in or commercial associations with the content of this article.
Tony Chieh-Ting Huang, M.D., M.Sc.
M. Diya Sabbagh, M.D.
Kian Adabi, B.A.
Steven L. Moran, M.D.
Division of Plastic and Reconstructive Surgery
Mayo Clinic
Rochester, Minn.
Chun-Kuan Lu, M.D.
Department of Orthopedics
Kaohsiung Medical University Hospital
Kaohsiung, Taiwan
Si-Gyun Roh, M.D.
Division of Plastic and Reconstructive Surgery
Mayo Clinic
Rochester, Minn., and Department of Plastic and Reconstructive Surgery
Chonbuk National University Hospital
Jeonju, People’s Republic of Korea
Hsu-Tang Cheng, M.D.
Division of Plastic and Reconstructive Surgery
Asia University Hospital
Taichung, Taiwan
Chieh-Cheng Randy Huang, M.D.
Sunshine Coast University Hospital
Birtinya, Queensland, Australia
Oscar J. Manrique, M.D.
Division of Plastic and Reconstructive Surgery
Mayo Clinic
Rochester, Minn.
REFERENCES
1. Ibrahim AE, Sarhane KA, Selber JC. New frontiers in robotic-assisted microsurgical reconstruction. Clin Plast Surg. 2017;44:415423.
2. Choque-Velasquez J, Colasanti R, Collan J, Kinnunen R, Rezai Jahromi B, Hernesniemi J. Virtual reality glasses and “eye-hands blind technique” for microsurgical training in neurosurgery. World Neurosurg. 2018;112:126130.
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