RESEARCH PAPER

Unique Application of Mixed Reality to Reduce Preoperative Stress Levels in Surgical Oncology Patients

The goal of this pilot study was to assess whether preoperative stress levels in surgical oncology patients may be mitigated through patient education. This was accomplished by transforming CT and MRI files into segmented models using 3D slicer, an NIH funded medical imaging analysis and visualization software, then displaying those models utilizing augmented reality via the Microsoft HoloLens 2. Given the well-documented relationship between preoperative stress and negative post-operative sequelae including increased length of stay and complications, a means of decreasing stress through increased understanding and relatability may benefit both patient and care-providing institutions. For the pilot phase of this prospective cohort study, six surgical oncology patients who were scheduled for operations covering hepatobiliary, endocrine, colorectal, pancreatic, and gastric procedures were recruited. These patients received standard of care instruction during pre-operative clinic visits prior to their pre-operative admission. Radiological scans were anonymized, segmented, and validated by a staff radiologist for anatomical validity prior to being shown to the patient using two HoloLens 2 devices, with the primary unit controlling the view on the secondary unit that patients wore. The day before surgery, patients completed a 7-point Likert Amsterdam Preoperative Anxiety and Information Scale along with the Brief Measure of Emotional Preoperative Stress scale prior to viewing the holographic model to determine baseline stress. Subsequently, each patient was shown the holographic model created from their CT or MRI scan and given the opportunity to ask questions and provide commentary during a 10-15-minute period, after which a repeat stress questionnaire was administered. Patients were followed post-operatively for complications. As a cohort comparing before viewing to after viewing the model, patients expressed a decreased level of stress (5.5 vs 2.7) and anxiety (5.7 vs 2.8), along with increased comprehension (1.5 vs 5.7) and engagement with their diagnosis and surgical plan (2.7 vs 5.2). To date no complications have been reported among discharged and inpatient subjects. This study highlights the immense impact that patient education may have in mitigating pre-operative stress levels. Given the established positive correlation between stress and post-operative complications that are associated with increased costs and morbidity, this strategy creates a unique opportunity to address the issue before it arises. While this pilot study is promising, continued data collection is ongoing.