Is patient-specific pre-operative preparation feasible in a clinical environment? A systematic review and meta-analysis

Abstract

Technical difficulty of an operation is associated with patient and disease characteristics, indicating the necessity for surgeons to exercise patient-specific preparation. Such methods have been shown to be effective in the simulation suite, however, application in a real clinical environment has been sporadic. This systematic review attempts to answer if patient-specific preparation in challenging surgical procedures is feasible. A systematic review of OvidMedline, Embase and all Evidence Based Medicine review databases, was conducted in search of studies who described surgical rehearsals in all specialties. Following the application of defined inclusion and exclusion criteria relevant data were extracted and summarised. Descriptive synthesis was performed for all included studies and meta-analysis of data was applied when possible. Of fourty-nine studies included, thirty-seven were case-series, ten were non-randomised comparative trials and two randomised controlled trials. Accuracy of applied methods ranged from 66.7 to 100% and a good outcome was seen in 60-100% of operations. Meta-analysis of studies comparing rehearsals to real procedures (same patients) showed that simulated procedures were significantly faster than real ones (SMD ¼ À1.56 [À2.19, À0.93] p < 0.00001) but were similar in other outcomes (fluoroscopy time: SMD ¼ À0.1 [À0.63, 0.42] p ¼ 0.7, fluoroscopy volume: SMD ¼ À0.43[À0.97, 0.11], p ¼ 0.12). Meta-analysis of studies comparing pre-operative rehearsals to standard treatment (two distinct groups of patients), demonstrated that real procedures were performed quicker if pre-operative rehearsal took place (SMD ¼ À0.47 [À0.79, À0.16], P ¼ 0.003) but the immediate clinical outcome was similar for practiced and not practiced operations (SMD ¼0.03[À0.23, 0.29], p ¼ 0.82). Current evidence suggests that patient-specific pre-operative preparation is feasible and safe and decreases operational time.

Simulation-Based Virtual-Reality Patient-Specific Rehearsal Prior to Endovascular Procedures: A Systematic Review

“…This review included both virtual and physical models used for either patient-specific preoperative planning or rehearsal. This study concluded that PsR is safe and feasible in concordance with this review [ 28 ].…”

Preoperative Virtual Reality Surgical Rehearsal of Renal Access during Percutaneous Nephrolithotomy: A Pilot Study

“…The development and growth of health care simulations can put an end to this model and provide an opportunity to rehearse high-risk, complex, and rare surgical procedures in a safe environment rather than on an actual patient. Yiasemidou et al [15] conducted a meta-analysis of studies comparing preoperative rehearsals to standard treatment with two distinct groups of patients and demonstrated that real procedures were performed quicker if preoperative rehearsal took place. However, the immediate clinical outcome was similar for practiced and non-practiced operations.…”

“…However, the immediate clinical outcome was similar for practiced and non-practiced operations. Current evidence suggests that patient-specific preoperative preparation is feasible, safe, and decreases operational time [15][16][17][18].…”

Immersive Virtual Reality for Patient-Specific Preoperative Planning: A Systematic Review

“…Patient-specific preoperative planning enables surgeons to optimize approaches and anticipate difficulties, allowing for improved patient safety and decreased operative duration. 1 Cross-sectional medical imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) were first introduced in the 1970s, providing surgeons with the capacity to better diagnose and evaluate anatomic structures with 2-dimensional (2D) pictures. 2 , 3 However, these imaging techniques were unable to recreate complex 3-dimensional (3D) visualizations of anatomy as would be viewed in the operating room.…”