New visualization techniques for in utero surgery: amnioscopy with a three-dimensional head-mounted display and a computer-controlled endoscope

Visualization of Fluoroscopic Imaging in Orthopedic Surgery: Head-Mounted Display vs Conventional Monitor

Purpose. See-through head-mounted displays (HMDs) can be used to view fluoroscopic imaging during orthopedic surgical procedures. The goals of this study were to determine whether HMDs reduce procedure time, number of fluoroscopic images required, or number of head turns by the surgeon compared with standard monitors. Methods. Sixteen orthopedic surgery residents each performed fluoroscopy-guided drilling of 8 holes for placement of tibial nail distal interlocking screws in an anatomical model, with 4 holes drilled while using HMD and 4 holes drilled while using a standard monitor. Procedure time, number of fluoroscopic images needed, and number of head turns by the resident during the procedure were compared between the 2 modalities. Statistical significance was set at P < .05. Results. Mean (SD) procedure time did not differ significantly between attempts using the standard monitor (55 [37] seconds) vs the HMD (56 [31] seconds) (P = .73). Neither did mean number of fluoroscopic images differ significantly between attempts using the standard monitor vs the HMD (9 [5] images for each) (P = .84). Residents turned their heads significantly more times when using the standard monitor (9 [5] times) vs the HMD (1 [2] times) (P < .001). Conclusions. Head-mounted displays lessened the need for residents to turn their heads away from the surgical field while drilling holes for tibial nail distal interlocking screws in an anatomical model; however, there was no difference in terms of procedure time or number of fluoroscopic images needed using the HMD compared with the standard monitor.

Head-Mounted Display Use in Surgery: A Systematic Review

Purpose. We analyzed the literature to determine (1) the surgically relevant applications for which head-mounted display (HMD) use is reported; (2) the types of HMD most commonly reported; and (3) the surgical specialties in which HMD use is reported. Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched through August 27, 2017, for publications describing HMD use during surgically relevant applications. We identified 120 relevant English-language, non-opinion publications for inclusion. HMD types were categorized as “heads-up” (nontransparent HMD display and direct visualization of the real environment), “see-through” (visualization of the HMD display overlaid on the real environment), or “non–see-through” (visualization of only the nontransparent HMD display). Results. HMDs were used for image guidance and augmented reality (70 publications), data display (63 publications), communication (34 publications), and education/training (18 publications). See-through HMDs were described in 55 publications, heads-up HMDs in 41 publications, and non–see-through HMDs in 27 publications. Google Glass, a see-through HMD, was the most frequently used model, reported in 32 publications. The specialties with the highest frequency of published HMD use were urology (20 publications), neurosurgery (17 publications), and unspecified surgical specialty (20 publications). Conclusion. Image guidance and augmented reality were the most commonly reported applications for which HMDs were used. See-through HMDs were the most commonly reported type used in surgically relevant applications. Urology and neurosurgery were the specialties with greatest published HMD use.

Is it worth revisiting laparoscopic three-dimensional visualization? A validated assessment

OBJECTIVES

Pure laparoscopic urologic surgery is becoming the standard of care for many urologic procedures. Training surgeons without any experience in the field is still a challenge. It is well recognized that two-dimensional optics causes difficulty for the novice. Thus, we assessed a new-generation, three-dimensional (3D) visualization system.

METHODS

Fifteen laparoscopically novice surgeons were asked to perform five validated laparoscopic training exercises using the two-dimensional and 3D systems in random order: (a) linear cutting and suturing; (b) curved cutting and suturing; (c) tubular suturing; (d) dorsal vein complex suturing simulation; and (e) urethrovesical anastomosis. The objective (time taken to complete the task versus the time needed by an expert) and subjective (accuracy on completion versus an expert's) scoring were performed independently by advanced laparoscopists. Statistical analysis was performed using the t test.

RESULTS

All tasks were completed by the participants. The statistical analysis revealed a trend toward improved task performance using 3D visualization.

CONCLUSIONS

Our preliminary testing has suggested that the new-generation, 3D system used will be helpful for developing skills in laparoscopy for the novice surgeon.

Miniaturized three-dimensional endoscopic imaging system based on active stereovision

A miniaturized three-dimensional endoscopic imaging system is presented. The system consists of two imaging in channels that can be used to obtain an image from an object of interest and to project as tructured light onto the imaged object to measure the surface topology. The structured light was generated with a collimated monochromatic light source and a holographic binary phase grating. The imaging and projection channels were calibrated by use of a modified pinhole camera. The surface profile was extracted by use of triangulation between the projected feature points and the two channel ofthe endoscope. The imaging system was evaluated in three-dimensional measurements of several objects with known geometries. The results show that surface profiles of the objects with different surfaces and dimensions can be obtained at high accuracy. The in vivo measurements at tissue sites of human skin and an oral cavity demonstrated the potential of the technique for clinical applications.

New visualization technique with a three-dimensional video-assisted stereoendoscopic system: application of the BVHIS display method during endolaryngeal surgery

A three-dimensional video-assisted stereoendoscopic system (3D video system) developed by the Shinko Optical Company, Ltd. (Tokyo, Japan), and referred to as the binocular vision by horizontal image shifting display method (BVHIS display method), has been developed to digitally process ordinary video signals obtained with a video camera connected to a direct videolaryngoscope. The three-dimensional video system provides the surgeon with stereoendoscopic video images and enhances the ability of the surgeon to perform delicate endoscopic procedures. The three-dimensional video-assisted stereoendoscopic laryngosurgical procedure and its underlying principles are described in this paper. A total of 12 patients with laryngeal lesions causing dysphonia underwent three-dimensional video-assisted stereoendoscopic laryngosurgery. Although the video image obtained with the BVHIS display method is only pseudo-three-dimensional, this method enables the surgeon to perceive both depth perception and realism. We describe a surgical procedure using this new visualizing technique and the underlying principles of the technique. Preoperative and postoperative evaluations of the patients' vocal functions are also described. This system is a useful tool for the treatment of laryngeal lesions causing dysphonia.