A Randomized Pilot Trial of Virtual Reality Surgical Planning for Head and Neck Oncologic Resection.

IF 2.2 3区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Laryngoscope Pub Date : 2024-11-12 DOI:10.1002/lary.31874

Kathryn L Nunes, Victor Jegede, Derek S Mann, Pablo Llerena, Richard Wu, Leonard Estephan, Ayan Kumar, Sana Siddiqui, Raphael Banoub, Scott W Keith, Madalina Tuluc, Arielle G Thal, Richard Goldman, Leila J Mady, David M Cognetti, Adam J Luginbuhl, Michael C Topf, Joseph M Curry

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引用次数: 0

Abstract

Objective: Application of virtual reality (VR) for surgical planning may improve clinical outcomes for head and neck cancer (HNC) resection. There is a lack of randomized trials and meaningful metrics to assess such technological applications. Our objective was to evaluate the feasibility of a VR protocol for oncologic surgical planning and assess the impact on surgical outcomes.

Methods: A randomized controlled trial utilizing a VR Case Enhancement Protocol (VRCEP) versus standard of care (SOC) surgical planning was conducted. The primary endpoint was feasibility, defined as >80% successful VRCEPs. Metrics included surgeon task-load burden (TLB) using the NASA Task-Load Index and "margin events," defined as "the need for defect-driven margins, positive frozen margins, and/or positive final margins." Margin events were used to calculate a margin event score (MES) per case and margin event rate (MER) per cohort.

Results: Thirty-four patients were included in the final analysis (17 VRCEP, 17 SOC) with 94.4% of eligible VRCEP cases completed (17/18). Surgeon TLB was unchanged with VRCEP. Cases undergoing VRCEP were associated with a lower mean MES (0.27 vs. 0.94, p = 0.014) and MER (11.6% vs. 35.6%, p = 0.0041). VRCEP was associated with decreased defect-driven margins (10% vs. 53.3%, p = 0.032). Although not statistically significant, positive frozen and final margin rates were lower in VRCEP.

Conclusion: Completion of the VRCEP was feasible with no significant increase in surgeon TLB appreciated. VRCEP yielded fewer MEs. Further investigation into the benefit of VR in HNC resection is warranted. Margin events may represent useful metrics for assessing novel surgical technologies.

Level of evidence: 2 Laryngoscope, 2024.

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虚拟现实手术规划用于头颈部肿瘤切除术的随机试点试验。

目的：应用虚拟现实技术（VR）进行手术规划可提高头颈癌（HNC）切除术的临床疗效。目前缺乏随机试验和有意义的指标来评估此类技术应用。我们的目标是评估肿瘤手术规划 VR 方案的可行性，并评估其对手术效果的影响：方法：我们采用 VR 病例增强方案 (VRCEP) 与标准护理 (SOC) 手术计划进行了随机对照试验。主要终点是可行性，即 VRCEP 成功率大于 80%。衡量标准包括使用 NASA 任务负荷指数计算的外科医生任务负荷（TLB）和 "切缘事件"，"切缘事件 "的定义是 "需要缺陷驱动切缘、阳性冷冻切缘和/或阳性最终切缘"。边缘事件用于计算每个病例的边缘事件评分（MES）和每个队列的边缘事件发生率（MER）：34例患者纳入最终分析（17例VRCEP，17例SOC），94.4%符合条件的VRCEP病例已完成（17/18）。外科医生TLB与VRCEP相同。接受 VRCEP 的病例平均 MES（0.27 对 0.94，p = 0.014）和 MER（11.6% 对 35.6%，p = 0.0041）较低。VRCEP 与缺损驱动边缘减少有关（10% 对 53.3%，p = 0.032）。尽管没有统计学意义，但VRCEP的阳性冷冻切缘率和最终切缘率较低：结论：完成 VRCEP 是可行的，外科医生的 TLB 没有明显增加。VRCEP 产生的 ME 更少。有必要进一步研究 VR 在 HNC 切除术中的益处。边缘事件可能是评估新型外科技术的有用指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Laryngoscope 医学-耳鼻喉科学

CiteScore

6.50

自引率

7.70%

发文量

500

审稿时长

2-4 weeks

期刊介绍： The Laryngoscope has been the leading source of information on advances in the diagnosis and treatment of head and neck disorders since 1890. The Laryngoscope is the first choice among otolaryngologists for publication of their important findings and techniques. Each monthly issue of The Laryngoscope features peer-reviewed medical, clinical, and research contributions in general otolaryngology, allergy/rhinology, otology/neurotology, laryngology/bronchoesophagology, head and neck surgery, sleep medicine, pediatric otolaryngology, facial plastics and reconstructive surgery, oncology, and communicative disorders. Contributions include papers and posters presented at the Annual and Section Meetings of the Triological Society, as well as independent papers, "How I Do It", "Triological Best Practice" articles, and contemporary reviews. Theses authored by the Triological Society’s new Fellows as well as papers presented at meetings of the American Laryngological Association are published in The Laryngoscope. • Broncho-esophagology • Communicative disorders • Head and neck surgery • Plastic and reconstructive facial surgery • Oncology • Speech and hearing defects