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Ding H, Sun W, Zheng G. Robot-Assisted Augmented Reality (AR)-Guided Surgical Navigation for Periacetabular Osteotomy. SENSORS (BASEL, SWITZERLAND) 2024; 24:4754. [PMID: 39066150 PMCID: PMC11280818 DOI: 10.3390/s24144754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/11/2024] [Accepted: 07/20/2024] [Indexed: 07/28/2024]
Abstract
Periacetabular osteotomy (PAO) is an effective approach for the surgical treatment of developmental dysplasia of the hip (DDH). However, due to the complex anatomical structure around the hip joint and the limited field of view (FoV) during the surgery, it is challenging for surgeons to perform a PAO surgery. To solve this challenge, we propose a robot-assisted, augmented reality (AR)-guided surgical navigation system for PAO. The system mainly consists of a robot arm, an optical tracker, and a Microsoft HoloLens 2 headset, which is a state-of-the-art (SOTA) optical see-through (OST) head-mounted display (HMD). For AR guidance, we propose an optical marker-based AR registration method to estimate a transformation from the optical tracker coordinate system (COS) to the virtual space COS such that the virtual models can be superimposed on the corresponding physical counterparts. Furthermore, to guide the osteotomy, the developed system automatically aligns a bone saw with osteotomy planes planned in preoperative images. Then, it provides surgeons with not only virtual constraints to restrict movement of the bone saw but also AR guidance for visual feedback without sight diversion, leading to higher surgical accuracy and improved surgical safety. Comprehensive experiments were conducted to evaluate both the AR registration accuracy and osteotomy accuracy of the developed navigation system. The proposed AR registration method achieved an average mean absolute distance error (mADE) of 1.96 ± 0.43 mm. The robotic system achieved an average center translation error of 0.96 ± 0.23 mm, an average maximum distance of 1.31 ± 0.20 mm, and an average angular deviation of 3.77 ± 0.85°. Experimental results demonstrated both the AR registration accuracy and the osteotomy accuracy of the developed system.
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Affiliation(s)
| | | | - Guoyan Zheng
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; (H.D.); (W.S.)
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Liu X, Zhang Z, Han W, Zhao Z, Kim BS, Yan Y, Chen X, Wang X, Li X, Yang X, Wang B, Xu H, Lin L, Chai G. Efficacy of navigation system-assisted distraction osteogenesis for hemifacial microsomia based on artificial intelligence for 3 to 18 years old: study protocol for a randomized controlled single-blind trial. Trials 2024; 25:42. [PMID: 38216974 PMCID: PMC10785481 DOI: 10.1186/s13063-023-07809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Mandibular distraction osteogenesis (MDO) is a major part of the treatment for hemifacial microsomia patients. Due to the narrow surgical field of the intraoral approach, osteotomy accuracy is highly dependent on the surgeons' experience. Electromagnetic (EM) tracking systems can achieve satisfying accuracy to provide helpful real-time surgical navigation. Our research team developed an EM navigation system based on artificial intelligence, which has been justified in improving the accuracy of osteotomy in the MDO in animal experiments. This study aims to clarify the effect of the EM navigation system in improving the MDO accuracy for hemifacial microsomia patients. METHODS This study is designed as a single-centered and randomized controlled trial. Altogether, 22 hemifacial microsomia patients are randomly assigned to the experiment and control groups. All patients receive three-dimensional CT scans and preoperative surgical plans. The EM navigation system will be set up for those in the experiment group, and the control group will undergo traditional surgery. The primary outcome is the surgical precision by comparing the osteotomy position of pre- and postoperative CT scan images through the Geomagic Control software. The secondary outcomes include mandibular symmetry (occlusal plane deviation angle, mandibular ramus height, and body length), pain scale, and complications. Other indications, such as the adverse events of the system and the satisfactory score from patients and their families, will be recorded. DISCUSSION This small sample randomized controlled trial intends to explore the application of an EM navigation system in MDO for patients, which has been adopted in other surgeries such as orthognathic procedures. Because of the delicate structures of children and the narrow surgical view, accurate osteotomy and protection of nearby tissue from injury are essential for successful treatment. The EM navigation system based on artificial intelligence adopted in this trial is hypothesized to provide precise real-time navigation for surgeons and optimally improve patient outcomes, including function and aesthetic results. The results of this trial will extend the application of new navigation technology in pediatric plastic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200061565. Registered on 29 June 2022.
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Affiliation(s)
- Xiangqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Ziwei Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Yingjie Yan
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xuetong Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xin Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, 227 Chong Qing Nan Rd., Shanghai, 200025, China
| | - Haisong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
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Zhang Z, Zhao Z, Han W, Kim BS, Yan Y, Chen X, Lin L, Shen W, Chai G. Accuracy and safety of robotic navigation-assisted distraction osteogenesis for hemifacial microsomia. Front Pediatr 2023; 11:1158078. [PMID: 37228439 PMCID: PMC10203510 DOI: 10.3389/fped.2023.1158078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to verify the accuracy and safety of distraction osteogenesis for hemifacial microsomia assisted by a robotic navigation system based on artificial intelligence. Methods The small sample early-phase single-arm clinical study, available at http://www.chictr.org.cn/index.aspx, included children aged three years and older diagnosed with unilateral hemifacial microsomia (Pruzansky-Kaban type II). A preoperative design was performed, and an intelligent robotic navigation system assisted in the intraoperative osteotomy. The primary outcome was the accuracy of distraction osteogenesis, including the positional and angular errors of the osteotomy plane and the distractor, by comparing the preoperative design plan with the actual images one week postoperatively. Perioperative indicators, pain scales, satisfaction scales, and complications at one week were also analyzed. Results Four cases (mean 6.5 years, 3 type IIa and 1 type IIb deformity) were included. According to the craniofacial images one week after surgery, the osteotomy plane positional error was 1.77 ± 0.12 mm, and the angular error was 8.94 ± 4.13°. The positional error of the distractor was 3.67 ± 0.23 mm, and the angular error was 8.13 ± 2.73°. Postoperative patient satisfaction was high, and no adverse events occurred. Discussion The robotic navigation-assisted distraction osteogenesis in hemifacial microsomia is safe, and the operational precision meets clinical requirements. Its clinical application potential is to be further explored and validated.
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Affiliation(s)
- Ziwei Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yingjie Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weimin Shen
- Department of Burn and Plastic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Feasibility of a Robot-Assisted Surgical Navigation System for Mandibular Distraction Osteogenesis in Hemifacial Microsomia: A Model Experiment. J Craniofac Surg 2023; 34:525-531. [PMID: 36173942 DOI: 10.1097/scs.0000000000009028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the feasibility and accuracy of osteotomy and distractor placement using a robotic navigation system in a model surgical experiment of mandibular distraction osteogenesis for hemifacial microsomia. Imaging data from 5 patients with Pruzansky-Kaban type II (IIa: 4; IIb: 1) mandibular deformities were used to print 3D models for simulated mandibular distraction osteogenesis. In the experimental group, a robot-assisted surgical navigation system was used to perform the surgery under robotic guidance following registration, according to the preoperative design. Conventional surgery was performed in the control group, in which the operation was based on intraoperative estimations of the preoperative design by experienced surgeons. The accuracies of the osteotomy and distractor placement were assessed based on distance and angular error. Osteotomy accuracy was higher in the experimental group than in the control group, and the distance error ( t =9.311, P <0.001) and angular error ( t =5.385, P =0.001) were significantly reduced. The accuracy of distractor placement was also significantly higher in the experimental group, while the distance error ( t =3.048, P =0.016) and angular error ( t =3.524, P =0.024) were significantly reduced. The present results highlight the feasibility of robot-assisted distraction osteogenesis combined with electromagnetic navigation for improved surgical precision in clinical settings.
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Advances in Robot-Assisted Surgery for Facial Bone Contouring Surgery. J Craniofac Surg 2023; 34:813-816. [PMID: 36730634 DOI: 10.1097/scs.0000000000009128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023] Open
Abstract
Since our team reported the application of robot-assisted surgery in facial contouring surgery in 2020, further clinical trials with large samples have been conducted. This paper will report the interim results of a single-center, large-sample randomized controlled trial of the first robot developed by our team for facial contouring surgery. Meanwhile, this research field will be systematically reviewed and prospected.
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Wu J, Hui W, Huang J, Luan N, Lin Y, Zhang Y, Zhang S. The Feasibility of Robot-Assisted Chin Osteotomy on Skull Models: Comparison with Surgical Guides Technique. J Clin Med 2022; 11:jcm11226807. [PMID: 36431284 PMCID: PMC9696640 DOI: 10.3390/jcm11226807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Surgical robotic technology is characterized by its high accuracy, good stability, and repeatability. The accuracy of mandibular osteotomy is important in tumor resection, function reconstruction, and abnormality correction. This study is designed to compare the operative accuracy between robot-assisted osteotomy and surgical guide technique in the skull model trials which simulated the genioplasty. In an experimental group, robot-assisted chin osteotomy was automatically performed in 12 models of 12 patients according to the preoperative virtual surgical planning (VSP). In a control group, with the assistance of a surgical guide, a surgeon performed the chin osteotomy in another 12 models of the same patients. All the mandibular osteotomies were successfully completed, and then the distance error and direction error of the osteotomy plane were measured and analyzed. The overall distance errors of the osteotomy plane were 1.57 ± 0.26 mm in the experimental group and 1.55 ± 0.23 mm in the control group, and the direction errors were 7.99 ± 1.10° in the experimental group and 8.61 ± 1.05° in the control group. The Bland-Altman analysis results revealed that the distance error of 91.7% (11/12) and the direction error of 100% (12/12) of the osteotomy plane were within the 95% limits of agreement, suggesting the consistency of differences in the osteotomy planes between the two groups. Robot-assisted chin osteotomy is a feasible auxiliary technology and achieves the accuracy level of surgical guide-assisted manual operation.
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Affiliation(s)
- Jinyang Wu
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Wenyu Hui
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Department of Stomatology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Jianhua Huang
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Nan Luan
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yanping Lin
- Department of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yong Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
| | - Shilei Zhang
- Department of Oral and Cranio-Maxillofacial Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
- Correspondence: (Y.Z.); (S.Z.); Tel.: +86-021-2327-1699-5656 (Y.Z. & S.Z.); Fax: +86-021-6313-6856 (Y.Z. & S.Z.)
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Preliminary study of the accuracy and safety of robot-assisted mandibular distraction osteogenesis with electromagnetic navigation in hemifacial microsomia using rabbit models. Sci Rep 2022; 12:19572. [PMID: 36379999 PMCID: PMC9666469 DOI: 10.1038/s41598-022-21893-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the accuracy and safety of mandibular osteotomy and distraction device positioning in distraction osteogenesis assisted by an electromagnetic navigation surgical robot. Twelve New Zealand white rabbits were randomly divided into two groups after computed tomography. The control group underwent a procedure based on the preoperative three-dimensional design and clinical experience. Animals in experimental group underwent a procedure with robotic assistance after registration. The accuracies of osteotomy and distraction device positioning were analysed based on distance and angular errors. The change in ramus length after a 1 cm-extension of the distraction device was for assessing distraction effect. The preparation, operative and osteotomy times, intraoperative bleeding, and teeth injury were used for safety assessment. In the experimental group, the distance (t = 2.591, p = 0.011) and angular (t = 4.276, p = 0.002) errors of osteotomy plane, and the errors in distraction device position (t = 3.222, p = 0.009) and direction (t = 4.697, p = 0.001) were lower; the distraction effect was better (t = 4.096, p = 0.002). There was no significant difference in the osteotomy time and bleeding; however, the overall operative and preparation times were increased in the experimental group, with a reduced rate of teeth damage. Robot-assisted mandibular distraction osteogenesis with electromagnetic navigation in craniofacial microsomia is feasible, safe, significantly improves surgical precision.
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Lin L, Sun M, Xu C, Gao Y, Xu H, Yang X, He H, Wang B, Xie L, Chai G. Assessment of Robot-Assisted Mandibular Contouring Surgery in Comparison With Traditional Surgery: A Prospective, Single-Center, Randomized Controlled Trial. Aesthet Surg J 2022; 42:567-579. [PMID: 34791018 DOI: 10.1093/asj/sjab392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few clinical studies on robot-assisted surgery (RAS) for mandibular contouring have been reported. OBJECTIVES The aim of this study was to follow the long-term effectiveness and safety of RAS for craniofacial bone surgery. METHODS This small-sample, early-phase, prospective, randomized controlled study included patients diagnosed with mandibular deformity requiring mandibular contouring surgery. Patients of both genders aged 18 to 30 years without complicated craniofacial repair defects were enrolled and randomly assigned in a 1:1 ratio by a permuted-block randomized assignments list generated by the study statistician. The primary outcomes were the positioning accuracy and accuracy of the osteotomy plane angle 1 week after surgery. Surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications at 1 week, 1 month, and 6 months after surgery were also analyzed. RESULTS One patient was lost to follow-up, resulting in a total of 14 patients in the traditional surgery group and 15 in the robot-assisted group (mean [standard deviation] age, 22.65 [3.60] years). Among the primary outcomes, there was a significant difference in the positioning accuracy (2.91 mm vs 1.65 mm; P < 0.01) and angle accuracy (13.26º vs 4.85º; P < 0.01) between the 2 groups. Secondary outcomes did not significantly differ. CONCLUSIONS Compared to traditional surgery, robot-assisted mandibular contouring surgery showed improved precision in bone shaving, as well as higher safety. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Mengzhe Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Cheng Xu
- Institute of Forming Technology and Equipment, Shanghai Jiao Tong University, Xuhui Campus , Shanghai, China
| | - Yuan Gao
- Institute of Forming Technology and Equipment, Shanghai Jiao Tong University, Xuhui Campus , Shanghai, China
| | - Haisong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
| | - Hao He
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Le Xie
- Institute of Medical Robotics, Shanghai Jiao Tong University, Minhang Campus , Shanghai, China
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai, China
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