Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial

Yiasemidou, M; Mushtaq, F; Basheer, M; Galli, R; Panagiotou, D; Stock, S; Preston, N; Mon-Williams, M; Jayne, D G; Miskovic, D

Abstract

Background
It was hypothesized that preparing for a surgical procedure, taking into account individual patient characteristics, may facilitate the procedure and improve surgical quality. The aim of this study was to compare different case-specific, preoperative mental rehearsal methods before minimally invasive rectal cancer surgery.

Methods
In this RCT, patients were allocated in a 1 : 1 : 1 : 1 ratio to four groups: systematic mental rehearsal (SMR) using MRI scans; SMR and three-dimensional (3D) virtual models; SMR and synthetic 3D printed models; and routine practice (control group). Surgeons operating on all but the control group underwent mental rehearsal with the visual aids, including axial MRI scans of the pelvis, interactive 3D virtual models reconstructed from axial MRIs, and synthetic models, manufactured by 3D printing. Operations were video-recorded and assessed by two experts blinded to allocation using two validated scores, the Competency Assessment Tool (CAT) and Objective Clinical Human Reliability Analysis (OCHRA). The primary outcome of the study was surgical performance, measured by the CAT.

Results
Forty-nine patients were randomized and allocated to the four groups. There were 12 participants in each of the control, MRI and SMR, and virtual and SMR groups, whereas the SMR using physical models and simulation group included 13. No difference was observed between groups in median CAT scores (control 30.50, MRI 34.25, virtual 31.75, physical 34.00; P = 0.748, partial η2 0.200, pη2 =0.052–0.088). Time spent not performing dissection was significantly shorter for the SMR with MRI group than for the control (57.5 versus 42 respectively; P < 0.001, pη2 =0.212).

Conclusion
Mental rehearsal did not affect CAT and OCHRA scores of consultant surgeons. Reference number: ISRCTN 75603704 (https://www.isrctn.com).

Citation

Yiasemidou, M., Mushtaq, F., Basheer, M., Galli, R., Panagiotou, D., Stock, S., Preston, N., Mon-Williams, M., Jayne, D. G., & Miskovic, D. (2021). Patient-specific mental rehearsal with three-dimensional models before low anterior resection: randomized clinical trial. BJS Open, 5(2), Article zraa004. https://doi.org/10.1093/bjsopen/zraa004

• Journal Article Type: Article
• Acceptance Date: Sep 14, 2020
• Online Publication Date: Dec 31, 2020
• Publication Date: 2021-03
• Deposit Date: Jan 6, 2021
• Publicly Available Date: Jul 6, 2021
• Journal: BJS Open
• Print ISSN: 2474-9842
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 2
• Article Number: zraa004
• DOI: https://doi.org/10.1093/bjsopen/zraa004
• Public URL: https://hull-repository.worktribe.com/output/3688367