Use of a head-mounted display during endoscopic graft harvesting: Expensive toy or sophisticated tool to optimize hand-eye coordination

Abstract

Objectives: Endoscopic graft harvesting (EVH) rapidly evolved over the last years. The technique results in significant benefit for patients and EVH has been recommended as standard of care recently. However the implementation in Germany is rather slow. One of the potential causes is the longer harvesting time and a substantial learning curve associated with EVH. A newly developed head-mounted display (HMD) (Fig.1) might improve hand-eye coordination without the need for a conventional monitor (floor mounted monitor). We investigated if this new device influences harvesting time and learning curve. Methods: Graft harvesting was performed using a specifically designed training model with fake plastic veins. This model guarantees a standardized set-up and comparability. Five surgeons performed 20 graft harvestings each, alternating with the help of the HMD or using a conventional display. Two of the surgeons already had performed endoscopic graft harvesting. The others had no endoscopic experience. After each completed graft harvest the test person and an observer completed a questionnaire to evaluate graft quality, harvesting time and learning curve. Results: As expected a pronounced learning curve regarding harvesting times was visible between experienced and inexperienced surgeons. In the group of inexperienced surgeons the use of the HMD demonstrated no significant impact on the learning curve compared to the conventional display setup. In the experienced group after a short adjustment period with the HMD there was no significant difference in the harvesting time compared to the use of a conventional display. Conclusion: The use of a HMD is a comparable alternative to a conventional display. It could be useful in operating rooms with restricted space conditions and no appropriate location for a conventional display. However the use of a head-mounted display facilitating potential improved hand-eye coordination had no impact on harvesting time or learning curve.