gms | German Medical Science

Introduction: Brain surgery with awake patient is a technique increasingly widespread in the world that allows to remove or reduce some tumors avoiding possible sequelae, similarly perform other routine procedures with awake patient such as deep brain stimulation for abnormal movements, where it is necessary to perform electrophysiological monitoring and evaluate the motor or behavioral response in real time; This situation is safe for the functionality and result of surgery, but it is stressful for patients, who must deal with noise, comments from the surgical group and other variants such as failure or absence of any material in the operating room.

Objective: To report our experience in the design of a virtual reality system, augmented and neurogaming for the education and entertainment of patients in the operating room.

Methods: This was a prospective, cross-sectional observational study. Anatomical images of augmented reality of the brain were developed that allowed to differentiate the basal nuclei and some internal structures, with which we educated the patients before the procedure, about the nature of the pathology and the surgical approach. The imaging technology of images was implemented. third-dimensional (3D) technology in augmented reality from screen to hand. Additionally, interactive images of the brain, cerebellum and spinal cord were designed to distract patients during surgery. Twenty patients undergoing surgery with awake patients were evaluated. The patients were divided into two groups, the first group (10 patients) used the technological aids before and intra-surgically the second group (10 patients) was operated as is usually done without methods of entertainment. The level of intra-surgical stress was compared in each of the two groups.

Stress generators for patients in the operating room were recorded in real time by a trained observer, using a previously validated instrument.

The frequency and intensity of the following factors generating stress in the patient were recorded and whether or not they perceived them when they were distracted with technology, occupying their mind:

1.

external personnel entering, leaving or initiating irrelevant conversations regarding the case

2.

irrelevant conversations within the surgical team

3.

acoustic noises (telephones, cell phones, pagers, radio) and external noises

4.

equipment (non-availability or failure)

5.

procedural, intrinsic to surgical work (eg, surgeon operating slower to teach the students they observe)

6.

work environment, related to the environment of the operating room (for example, electrocautery pedal placed in the wrong place)

The short version of the STAI was used to capture stress [31], which has been validated for use in the OS [32]. The STAI measures stress using 6 items: 3 positives ("I feel calm", "I feel content" and "I feel relaxed") and 3 negatives ("I feel tense", "I feel upset" and "I feel worried" "), all self-classified on a scale of 4 points, giving - consequently - a total score of 6 to 24. Higher scores indicate greater stress. Positive items are coded backwards for analysis.

Data analysis Data were analyzed using the SPSS statistical program (SPSS, Chicago, IL). The descriptive statistics (means and standard deviations [SD]) were computed for all measurements. The analysis of variance (ANOVA) was conducted to explore the presence of significant differences in teamwork, workload and stress levels in patients. Statistical significance was established for

Results: The mean stress score for patients who operated conventionally (without entertainment) was 16 (SD = 6.73), while for patients who received augmented reality, virtual or neurogaming was 8.07 (SD = 2.83), patients were significantly quieter when we used P <0.05 technology. During the procedure greater comfort and distraction of the patients was achieved, minimizing the agitation and anxiety in the surgery. In the immediate postoperative period of the patients, the procedure performed was shown to be satisfactory.

Conclusion: We recommend the virtual reality technique as a safe alternative of education and intraoperative distraction of patients who are going to perform a surgical procedure with awake patients.

Figure 1 [Fig. 1], Figure 2 [Fig. 2], Figure 3 [Fig. 3], Figure 4 [Fig. 4], Figure 5 [Fig. 5], Figure 6 [Fig. 6].

Key words: augmented reality, neurosurgery, patient education, craniotomy with awake patient