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Doornbos MCJ, Peek JJ, Maat APWM, Ruurda JP, De Backer P, Cornelissen BMW, Mahtab EAF, Sadeghi AH, Kluin J. Augmented Reality Implementation in Minimally Invasive Surgery for Future Application in Pulmonary Surgery: A Systematic Review. Surg Innov 2024; 31:646-658. [PMID: 39370802 DOI: 10.1177/15533506241290412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
OBJECTIVE This systematic review investigates of Augmented Reality (AR) systems used in minimally invasive surgery of deformable organs, focusing on initial registration, dynamic tracking, and visualization. The objective is to acquire a comprehensive understanding of the current knowledge, applications, and challenges associated with current AR-techniques, aiming to leverage these insights for developing a dedicated AR pulmonary Video or Robotic Assisted Thoracic Surgery (VATS/RATS) workflow. METHODS A systematic search was conducted within Embase, Medline (Ovid) and Web of Science on April 16, 2024, following the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). The search focused on intraoperative AR applications and intraoperative navigational purposes for deformable organs. Quality assessment was performed and studies were categorized according to initial registration and dynamic tracking methods. RESULTS 33 articles were included, of which one involved pulmonary surgery. Studies used both manual and (semi-) automatic registration methods, established through anatomical landmark-based, fiducial-based, or surface-based techniques. Diverse outcome measures were considered, including surgical outcomes and registration accuracy. The majority of studies that reached an registration accuracy below 5 mm applied surface-based registration. CONCLUSIONS AR can potentially aid surgeons with real-time navigation and decision making during anatomically complex minimally invasive procedures. Future research for pulmonary applications should focus on exploring surface-based registration methods, considering their non-invasive, marker-less nature, and promising accuracy. Additionally, vascular-labeling-based methods are worth exploring, given the importance and relative stability of broncho-vascular anatomy in pulmonary VATS/RATS. Assessing clinical feasibility of these approaches is crucial, particularly concerning registration accuracy and potential impact on surgical outcomes.
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Affiliation(s)
- Marie-Claire J Doornbos
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology & Erasmus University Medical Center Rotterdam, Leiden, The Netherlands
| | - Jette J Peek
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Bart M W Cornelissen
- Department of Cranio-Maxillofacial surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Amir H Sadeghi
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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A survey of augmented reality methods to guide minimally invasive partial nephrectomy. World J Urol 2023; 41:335-343. [PMID: 35776173 DOI: 10.1007/s00345-022-04078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/21/2022] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Minimally invasive partial nephrectomy (MIPN) has become the standard of care for localized kidney tumors over the past decade. The characteristics of each tumor, in particular its size and relationship with the excretory tract and vessels, allow one to judge its complexity and to attempt predicting the risk of complications. The recent development of virtual 3D model reconstruction and computer vision has opened the way to image-guided surgery and augmented reality (AR). OBJECTIVE Our objective was to perform a systematic review to list and describe the different AR techniques proposed to support PN. MATERIALS AND METHODS The systematic review of the literature was performed on 12/04/22, using the keywords "nephrectomy" and "augmented reality" on Embase and Medline. Articles were considered if they reported surgical outcomes when using AR with virtual image overlay on real vision, during ex vivo or in vivo MIPN. We classified them according to the registration technique they use. RESULTS We found 16 articles describing an AR technique during MIPN procedures that met the eligibility criteria. A moderate to high risk of bias was recorded for all the studies. We classified registration methods into three main families, of which the most promising one seems to be surface-based registration. CONCLUSION Despite promising results, there do not exist studies showing an improvement in clinical outcomes using AR. The ideal AR technique is probably yet to be established, as several designs are still being actively explored. More clinical data will be required to establish the potential contribution of this technology to MIPN.
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Roberts S, Desai A, Checcucci E, Puliatti S, Taratkin M, Kowalewski KF, Gomez Rivas J, Rivero I, Veneziano D, Autorino R, Porpiglia F, Gill IS, Cacciamani GE. "Augmented reality" applications in urology: a systematic review. Minerva Urol Nephrol 2022; 74:528-537. [PMID: 35383432 DOI: 10.23736/s2724-6051.22.04726-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Augmented reality (AR) applied to surgical procedures refers to the superimposition of preoperative or intra-operative images onto the operative field. Augmented reality has been increasingly used in myriad surgical specialties including Urology. The following study reviews advances in the use of AR for improvements in urologic outcomes. EVIDENCE ACQUISITION We identified all descriptive, validity, prospective randomized/nonrandomized trials and retrospective comparative/noncomparative studies about the use of AR in Urology up until March 2021. The MEDLINE, Scopus, and Web of Science databases were used for literature search. We conducted the study selection according to the PRISMA (Preferred Reporting Items for Systematic Reviews and meta-analysis statement) guidelines. We limited included studies to only those using AR, excluding all that used virtual reality technology. EVIDENCE SYNTHESIS A total of 60 studies were identified and included in the present analysis. Overall, 19 studies were descriptive/validity/phantom studies for specific AR methodologies, 4 studies were case reports, and 37 studies included clinical prospective/retrospective comparative studies. CONCLUSIONS Advances in AR have led to increasing registration accuracy as well as increased ability to identify anatomic landmarks and improve outcomes during Urologic procedures such as RARP and robot-assisted partial nephrectomy.
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Affiliation(s)
- Sidney Roberts
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Aditya Desai
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Enrico Checcucci
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.,European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands
| | - Stefano Puliatti
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| | - Mark Taratkin
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Karl-Friedrich Kowalewski
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Virgen Macarena University Hospital, Seville, Spain.,Department of Urology and Urosurgery, University Hospital of Mannheim, Mannheim, Germany
| | - Juan Gomez Rivas
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Ines Rivero
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology and Nephrology, Virgen del Rocío University Hospital, Seville, Spain
| | - Domenico Veneziano
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Department of Urology, Riuniti Hospital, Reggio Calabria, Reggio Calabria, Italy
| | | | - Francesco Porpiglia
- European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands
| | - Inderbir S Gill
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA.,Artificial Intelligence (AI) Center at USC Urology, USC Institute of Urology, Los Angeles, CA, USA
| | - Giovanni E Cacciamani
- Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Los Angeles, CA, USA - .,European Association of Urology (EAU) Young Academic Office (YAU) Uro-Technology Working Group, Arnhem, the Netherlands.,Artificial Intelligence (AI) Center at USC Urology, USC Institute of Urology, Los Angeles, CA, USA.,Keck School of Medicine, Department of Radiology, University of Southern California, Los Angeles, CA, USA
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Esperto F, Prata F, Autrán-Gómez AM, Rivas JG, Socarras M, Marchioni M, Albisinni S, Cataldo R, Scarpa RM, Papalia R. New Technologies for Kidney Surgery Planning 3D, Impression, Augmented Reality 3D, Reconstruction: Current Realities and Expectations. Curr Urol Rep 2021; 22:35. [PMID: 34031768 PMCID: PMC8143991 DOI: 10.1007/s11934-021-01052-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/13/2022]
Abstract
Purpose of review We aim to summarize the current state of art about 3D applications in urology focusing on kidney surgeries. In addition we aim to provide a snapshot about future perspective of intraoperative applications of augmented reality (AR). Recent findings A variety of applications in different fields have been proposed. Many applications concern current realities and 3D reconstruction, while some others are about future perspective. The majority of recent studies have focused their attention on preoperative surgical planning, patient education, surgical training, and AR. Summary The disposability of 3D models in healthcare scenarios might improve surgical outcomes, learning curves of novice surgeons and residents, as well as patients’ understanding and compliance, allowing a more shared surgical decision-making.
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Affiliation(s)
| | - Francesco Prata
- Department of Urology, Campus Bio-Medico University, Rome, Italy.
| | | | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, Madrid, Spain
| | - Moises Socarras
- Department of Urology, Instituto de Cirugia Urologica Avanzada (ICUA), Madrid, Spain
| | - Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Simone Albisinni
- Urology Department, University Clinics of Brussels, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Rita Cataldo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
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Zhang H, Sun Q, Liu Z. Augmented reality display of neurosurgery craniotomy lesions based on feature contour matching. COGNITIVE COMPUTATION AND SYSTEMS 2021. [DOI: 10.1049/ccs2.12021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hao Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control School of Mechanical Engineering Tianjin University of Technology Tianjin China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education Tianjin University of Technology Tianjin China
| | - Qi‐Yuan Sun
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control School of Mechanical Engineering Tianjin University of Technology Tianjin China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education Tianjin University of Technology Tianjin China
| | - Zhen‐Zhong Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control School of Mechanical Engineering Tianjin University of Technology Tianjin China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education Tianjin University of Technology Tianjin China
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Laparoscopic augmented reality registration for oncological resection site repair. Int J Comput Assist Radiol Surg 2021; 16:1577-1586. [PMID: 33797689 PMCID: PMC8354909 DOI: 10.1007/s11548-021-02336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/25/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Resection site repair during laparoscopic oncological surgery (e.g. laparoscopic partial nephrectomy) poses some unique challenges and opportunities for augmented reality (AR) navigation support. This work introduces an AR registration workflow that addresses the time pressure that is present during resection site repair. METHODS We propose a two-step registration process: the AR content is registered as accurately as possible prior to the tumour resection (the primary registration). This accurate registration is used to apply artificial fiducials to the physical organ and the virtual model. After the resection, these fiducials can be used for rapid re-registration (the secondary registration). We tested this pipeline in a simulated-use study with [Formula: see text] participants. We compared the registration accuracy and speed for our method and for landmark-based registration as a reference. RESULTS Acquisition of and, thereby, registration with the artificial fiducials were significantly faster than the initial use of anatomical landmarks. Our method also had a trend to be more accurate in cases in which the primary registration was successful. The accuracy loss between the elaborate primary registration and the rapid secondary registration could be quantified with a mean target registration error increase of 2.35 mm. CONCLUSION This work introduces a registration pipeline for AR navigation support during laparoscopic resection site repair and provides a successful proof-of-concept evaluation thereof. Our results indicate that the concept is better suited than landmark-based registration during this phase, but further work is required to demonstrate clinical suitability and applicability.
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Zhuang Y, Sun J, Liu J. Diagnosis of Chronic Kidney Disease by Three-Dimensional Contrast-Enhanced Ultrasound Combined with Augmented Reality Medical Technology. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5542822. [PMID: 33791081 PMCID: PMC7994090 DOI: 10.1155/2021/5542822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
Chronic kidney disease is a worldwide clinical and public health problem. As a risk factor for cardiovascular and cerebrovascular diseases, the disease has gradually become one of the causes of morbidity and death. As a routine method of screening for kidney disease, ultrasound is very important in improving the rate of early detection and accuracy of chronic kidney disease. This article explores the value of applying 3D ultrasound in conjunction with augmented reality medical technology in chronic kidney disease, observing changes in kidney tumor at different stages with percutaneous 3D ultrasound in patients with chronic kidney disease. Volunteers with chronic kidney disease were selected for this experiment. Among them, 160 males and 140 females were diagnosed as chronic kidney disease by clinical or renal pathological biopsy, and they all met the K/DOQI diagnostic criteria for chronic kidney disease. The selected subjects met the criteria and were divided into 5 groups, each with 60 patients, to explore the correlation of properties such as three-dimensional ultrasound kidney volume in different stages of chronic kidney disease. Experiments have shown that, with the increase in the stages of chronic kidney disease, the elasticity and volume of the renal parenchyma decrease, and the resistance index of the renal artery becomes larger, P < 0.05; the difference is statistically significant, indicating that the elasticity of the renal parenchyma is associated with chronic kidney disease. The stage is negatively correlated, and the resistance index of the renal artery is positively correlated with the stage of chronic kidney disease. That is, as the stage of chronic kidney disease increases, the three-dimensional volume of the kidney shows a decreasing trend and the resistance index of the renal artery shows an increasing trend. Speed shows a declining trend and there is some correlation between the three.
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Affiliation(s)
- Yan Zhuang
- Department of Nephrology, Linyi Central Hospital, Linyi 276400, Shandong, China
| | - Juanjuan Sun
- Department of Nephrology, Linyi Central Hospital, Linyi 276400, Shandong, China
| | - Jiaqiang Liu
- Hemodialysis of Linyi Central Hospital, Linyi 276400, Shandong, China
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3D-printed models and virtual reality as new tools for image-guided robot-assisted nephron-sparing surgery: a systematic review of the newest evidences. Curr Opin Urol 2020; 30:55-64. [PMID: 31725000 DOI: 10.1097/mou.0000000000000686] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Nowadays, kidney cancer surgery has been focusing on a patient-tailored management, expanding the indication to nephron-sparing surgery (NSS). Starting from computer tomography images, 3D models can be created, allowing a never experienced before understanding of surgical anatomy. Once obtained the models can be printed or virtually visualized with the aid to assist the surgeon in preoperative planning and simulation or intraoperative navigation. The aim of this systematic review is to assess the preoperative and intraoperative impact of 3D printed and virtual imaging for robotic NSS. RECENT FINDINGS Ten articles were found to meet the inclusion criteria and reviewed. An 'intermediate' score was assessed to the overall articles' quality. A moderate/high risk of bias was recorded for all the studies. SUMMARY 3D-printed models were considered to be more useful during both preoperative simulations and patients' counseling. These models guaranteed a better comprehension of anatomical structures and surgical procedure. Costs and quality of the materials available represent the two main limits of this developing technology.Instead, in a virtual reality setting the preoperative planning was enhanced by using 3D virtual models in a mixed reality environment. Intraoperatively, the possibility to overlap the 3D model to real anatomy allowed augmented reality procedures. This technology is still a 'newborn' and is constantly evolving, expanding day by day the range of its potential applications.
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Wake N, Nussbaum JE, Elias MI, Nikas CV, Bjurlin MA. 3D Printing, Augmented Reality, and Virtual Reality for the Assessment and Management of Kidney and Prostate Cancer: A Systematic Review. Urology 2020; 143:20-32. [DOI: 10.1016/j.urology.2020.03.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/19/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
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Qian L, Wu JY, DiMaio SP, Navab N, Kazanzides P. A Review of Augmented Reality in Robotic-Assisted Surgery. ACTA ACUST UNITED AC 2020. [DOI: 10.1109/tmrb.2019.2957061] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3D imaging applications for robotic urologic surgery: an ESUT YAUWP review. World J Urol 2019; 38:869-881. [DOI: 10.1007/s00345-019-02922-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
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Computer-assisted surgery: virtual- and augmented-reality displays for navigation during urological interventions. Curr Opin Urol 2019; 28:205-213. [PMID: 29278582 DOI: 10.1097/mou.0000000000000478] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the developments made for virtual- and augmented-reality navigation procedures in urological interventions/surgery. RECENT FINDINGS Navigation efforts have demonstrated potential in the field of urology by supporting guidance for various disorders. The navigation approaches differ between the individual indications, but seem interchangeable to a certain extent. An increasing number of pre- and intra-operative imaging modalities has been used to create detailed surgical roadmaps, namely: (cone-beam) computed tomography, MRI, ultrasound, and single-photon emission computed tomography. Registration of these surgical roadmaps with the real-life surgical view has occurred in different forms (e.g. electromagnetic, mechanical, vision, or near-infrared optical-based), whereby the combination of approaches was suggested to provide superior outcome. Soft-tissue deformations demand the use of confirmatory interventional (imaging) modalities. This has resulted in the introduction of new intraoperative modalities such as drop-in US, transurethral US, (drop-in) gamma probes and fluorescence cameras. These noninvasive modalities provide an alternative to invasive technologies that expose the patients to X-ray doses. Whereas some reports have indicated navigation setups provide equal or better results than conventional approaches, most trials have been performed in relatively small patient groups and clear follow-up data are missing. SUMMARY The reported computer-assisted surgery research concepts provide a glimpse in to the future application of navigation technologies in the field of urology.
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Joeres F, Schindele D, Luz M, Blaschke S, Russwinkel N, Schostak M, Hansen C. How well do software assistants for minimally invasive partial nephrectomy meet surgeon information needs? A cognitive task analysis and literature review study. PLoS One 2019; 14:e0219920. [PMID: 31318919 PMCID: PMC6638947 DOI: 10.1371/journal.pone.0219920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/04/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Intraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such systems, the first question to be asked is: What information does the surgeon need and when does he or she need it? In this article, we present an approach to investigate these surgeon information needs for minimally invasive partial nephrectomy and compare these needs to the relevant surgical computer assistance literature. MATERIALS AND METHODS First, we conducted a literature-based hierarchical task analysis of the surgical procedure. This task analysis was taken as a basis for a qualitative in-depth interview study with nine experienced surgical urologists. The study employed a cognitive task analysis method to elicit surgeons' information needs during minimally invasive partial nephrectomy. Finally, a systematic literature search was conducted to review proposed software assistance solutions for minimally invasive partial nephrectomy. The review focused on what information the solutions present to the surgeon and what phase of the surgery they aim to support. RESULTS The task analysis yielded a workflow description for minimally invasive partial nephrectomy. During the subsequent interview study, we identified three challenging phases of the procedure, which may particularly benefit from software assistance. These phases are I. Hilar and vascular management, II. Tumour excision, and III. Repair of the renal defects. Between these phases, 25 individual challenges were found which define the surgeon information needs. The literature review identified 34 relevant publications, all of which aim to support the surgeon in hilar and vascular management (phase I) or tumour excision (phase II). CONCLUSION The work presented in this article identified unmet surgeon information needs in minimally invasive partial nephrectomy. Namely, our results suggest that future solutions should address the repair of renal defects (phase III) or put more focus on the renal collecting system as a critical anatomical structure.
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Affiliation(s)
- Fabian Joeres
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Daniel Schindele
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Maria Luz
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Simon Blaschke
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Nele Russwinkel
- Department of Cognitive Modelling in Dynamic Human-Machine Systems, Technische Universität Berlin, Berlin, Germany
| | - Martin Schostak
- Clinic of Urology and Paediatric Urology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Christian Hansen
- Department of Simulation and Graphics, Faculty of Computer Science, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Bertolo R, Hung A, Porpiglia F, Bove P, Schleicher M, Dasgupta P. Systematic review of augmented reality in urological interventions: the evidences of an impact on surgical outcomes are yet to come. World J Urol 2019; 38:2167-2176. [PMID: 30826888 DOI: 10.1007/s00345-019-02711-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To perform a systematic literature review on the clinical impact of augmented reality (AR) for urological interventions. METHODS As of June 21, 2018, systematic literature review was performed via Medline, Embase and Cochrane databases in accordance with the PRISMA guidelines and registered at PROSPERO (CRD42018102194). Only full text articles in English were included, without time restrictions. Articles were considered if they reported on the use of AR during urological intervention and the impact on the surgical outcomes. The risk of bias and the quality of each study included were independently assessed using the standard Cochrane Collaboration risk of bias tool and the Risk Of Bias In Non-randomised Studies-of Interventions Tool (ROBINS-I). RESULTS 131 articles were identified. 102 remained after duplicate removal and were critically reviewed for evidence synthesis. 20 studies reporting on the outcomes of the use of AR during urological interventions in a clinical setting were considered. Given the mostly non-comparative design of the studies identified, the evidence synthesis was performed in a descriptive and narrative manner. Only one comparative study was found, with the remaining 19 items being single-arm observational studies. Based on the existing evidence, we are unable to state that AR improves the outcomes of urological interventions. The major limitation of AR-assisted surgery is inaccuracy in registration, translating into a poor navigation precision. CONCLUSIONS To date, there is limited evidence showing superior therapeutic benefits of AR-guided surgery when compared with the conventional surgical approach to the respective disease.
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Affiliation(s)
- Riccardo Bertolo
- Glickman Urological and Kidney Institute, Cleveland Clinic, 2050 E 96th St, Q Building, Cleveland, OH, 44195, USA. .,Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy.
| | - Andrew Hung
- Center for Robotic Simulation and Education, Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Pierluigi Bove
- Urology Department, "San Carlo di Nancy" Hospital, Rome, Italy
| | - Mary Schleicher
- Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, OH, USA
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Gibby JT, Swenson SA, Cvetko S, Rao R, Javan R. Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography. Int J Comput Assist Radiol Surg 2018; 14:525-535. [PMID: 29934792 DOI: 10.1007/s11548-018-1814-7] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Augmented reality has potential to enhance surgical navigation and visualization. We determined whether head-mounted display augmented reality (HMD-AR) with superimposed computed tomography (CT) data could allow the wearer to percutaneously guide pedicle screw placement in an opaque lumbar model with no real-time fluoroscopic guidance. METHODS CT imaging was obtained of a phantom composed of L1-L3 Sawbones vertebrae in opaque silicone. Preprocedural planning was performed by creating virtual trajectories of appropriate angle and depth for ideal approach into the pedicle, and these data were integrated into the Microsoft HoloLens using the Novarad OpenSight application allowing the user to view the virtual trajectory guides and CT images superimposed on the phantom in two and three dimensions. Spinal needles were inserted following the virtual trajectories to the point of contact with bone. Repeat CT revealed actual needle trajectory, allowing comparison with the ideal preprocedural paths. RESULTS Registration of AR to phantom showed a roughly circular deviation with maximum average radius of 2.5 mm. Users took an average of 200 s to place a needle. Extrapolation of needle trajectory into the pedicle showed that of 36 needles placed, 35 (97%) would have remained within the pedicles. Needles placed approximated a mean distance of 4.69 mm in the mediolateral direction and 4.48 mm in the craniocaudal direction from pedicle bone edge. CONCLUSION To our knowledge, this is the first peer-reviewed report and evaluation of HMD-AR with superimposed 3D guidance utilizing CT for spinal pedicle guide placement for the purpose of cannulation without the use of fluoroscopy.
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Affiliation(s)
- Jacob T Gibby
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Samuel A Swenson
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA
| | - Steve Cvetko
- Novarad Corporation, 752 East 1180 South, Suite 200, American Fork, UT, 84003, USA
| | - Raj Rao
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA.,Department of Orthopedic Surgery, George Washington University Hospital, 900 23rd St NW, Washington, DC, 20037, USA
| | - Ramin Javan
- School of Medicine and Health Sciences, George Washington University, 2300 I St NW, Washington, DC, 200052, USA. .,Department of Neuroradiology, George Washington University Hospital, 900 23rd St NW, Suite G2092, Washington, DC, 20037, USA.
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Speidel S, Bodenstedt S, Maier-Hein L, Kenngott H. Kognitive Chirurgie/Chirurgie 4.0. COLOPROCTOLOGY 2018. [DOI: 10.1007/s00053-018-0236-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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18
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Edgcumbe P, Singla R, Pratt P, Schneider C, Nguan C, Rohling R. Follow the light: projector-based augmented reality intracorporeal system for laparoscopic surgery. J Med Imaging (Bellingham) 2018; 5:021216. [PMID: 29487888 DOI: 10.1117/1.jmi.5.2.021216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/22/2018] [Indexed: 01/20/2023] Open
Abstract
A projector-based augmented reality intracorporeal system (PARIS) is presented that includes a miniature tracked projector, tracked marker, and laparoscopic ultrasound (LUS) transducer. PARIS was developed to improve the efficacy and safety of laparoscopic partial nephrectomy (LPN). In particular, it has been demonstrated to effectively assist in the identification of tumor boundaries during surgery and to improve the surgeon's understanding of the underlying anatomy. PARIS achieves this by displaying the orthographic projection of the cancerous tumor on the kidney's surface. The performance of PARIS was evaluated in a user study with two surgeons who performed 32 simulated robot-assisted partial nephrectomies. They performed 16 simulated partial nephrectomies with PARIS for guidance and 16 simulated partial nephrectomies with only an LUS transducer for guidance. With PARIS, there was a significant reduction [30% ([Formula: see text])] in the amount of healthy tissue excised and a trend toward a more accurate dissection around the tumor and more negative margins. The combined point tracking and reprojection root-mean-square error of PARIS was 0.8 mm. PARIS' proven ability to improve key metrics of LPN surgery and qualitative feedback from surgeons about PARIS supports the hypothesis that it is an effective surgical navigation tool.
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Affiliation(s)
- Philip Edgcumbe
- University of British Columbia, MD/PhD Program, Vancouver, Canada
| | - Rohit Singla
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Philip Pratt
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Caitlin Schneider
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada
| | - Christopher Nguan
- University of British Columbia, Department of Urological Sciences, Vancouver, Canada
| | - Robert Rohling
- University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada.,University of British Columbia, Department of Mechanical Engineering, Vancouver, Canada
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