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Kearns EC, Moynihan A, Dalli J, Khan MF, Singh S, McDonald K, O'Reilly J, Moynagh N, Myles C, Brannigan A, Mulsow J, Shields C, Jones J, Fenlon H, Lawler L, Cahill RA. Clinical validation of 3D virtual modelling for laparoscopic complete mesocolic excision with central vascular ligation for proximal colon cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108597. [PMID: 39173461 DOI: 10.1016/j.ejso.2024.108597] [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: 12/15/2023] [Revised: 05/26/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Laparoscopic Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) in colon cancer surgery has not been broadly adopted in part because of safety concerns. Pre-operative 3-D virtual modelling (3DVM) may help but needs validation. METHODS 3DVM were routinely constructed from CT mesenteric angiograms (CTMA) using a commercial service (Visible Patient, Strasbourg, France) for consecutive patients during our CMECVL learning curve over three years. 3DVMs were independently checked versus CTMA and operative findings. CMECVL outcomes were compared versus other patients undergoing standard mesocolic excision (SME) surgery laparoscopically in the same hospital as control. Stakeholders were studied regarding 3DVM use and usefulness (including detail retention) versus CTMA and a physical 3D-printed model. RESULTS 26 patients underwent 3DVM with intraoperative display during laparoscopic CMECVL within existing workflows. 3DVM accuracy was 96 % re arteriovenous variations at patient level versus CTMA/intraoperative findings including accessory middle colic artery identification in three patients. Twenty-two laparoscopic CMECVL with 3DVM cases were compared with 49 SME controls (age 69 ± 10 vs 70.9 ± 11 years, 55 % vs 53 % males). There were no intraoperative complications with CMECVL and similar 30-day postoperative morbidity (30 % vs 29 %), hospital stay (9 ± 3 vs 12 ± 13 days), 30-day readmission (6 % vs 4 %) and reoperation (0 % vs 4 %) rates. Intraoperative times were longer (215.7 ± 43.9 vs 156.9 ± 52.9 min, p=<0.01) but decreased significantly over time. 3DVM surveys (n = 98, 20 surgeons, 48 medical students, 30 patients/patient relatives) and comparative study revealed majority endorsement (90 %) and favour (87 %). CONCLUSION 3DVM use was positively validated for laparoscopic CMECVL and valued by clinicians, students, and patients alike.
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Affiliation(s)
- Emma C Kearns
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Alice Moynihan
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | - Jeffrey Dalli
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Sneha Singh
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Katherine McDonald
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jessica O'Reilly
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Niamh Moynagh
- UCD Centre for Precision Surgery, University College Dublin, Ireland
| | | | - Ann Brannigan
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jurgen Mulsow
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conor Shields
- Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Helen Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Leo Lawler
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ronan A Cahill
- UCD Centre for Precision Surgery, University College Dublin, Ireland; Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Chou DW, Annadata V, Willson G, Gray M, Rosenberg J. Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review. Laryngoscope 2024; 134:2568-2577. [PMID: 37947302 DOI: 10.1002/lary.31178] [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] [Received: 07/23/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Augmented reality (AR) and virtual reality (VR) are emerging technologies with wide potential applications in health care. We performed a scoping review of the current literature on the application of augmented and VR in the field of facial plastic and reconstructive surgery (FPRS). DATA SOURCES PubMed and Web of Science. REVIEW METHODS According to PRISMA guidelines, PubMed and Web of Science were used to perform a scoping review of literature regarding the utilization of AR and/or VR relevant to FPRS. RESULTS Fifty-eight articles spanning 1997-2023 met the criteria for review. Five overarching categories of AR and/or VR applications were identified across the articles: preoperative, intraoperative, training/education, feasibility, and technical. The following clinical areas were identified: burn, craniomaxillofacial surgery (CMF), face transplant, face lift, facial analysis, facial palsy, free flaps, head and neck surgery, injectables, locoregional flaps, mandible reconstruction, mandibuloplasty, microtia, skin cancer, oculoplastic surgery, rhinology, rhinoplasty, and trauma. CONCLUSION AR and VR have broad applications in FPRS. AR for surgical navigation may have the most emerging potential in CMF surgery and free flap harvest. VR is useful as distraction analgesia for patients and as an immersive training tool for surgeons. More data on these technologies' direct impact on objective clinical outcomes are still needed. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2568-2577, 2024.
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Affiliation(s)
- David W Chou
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vivek Annadata
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gloria Willson
- Education and Research Services, Levy Library, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mingyang Gray
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Rosenberg
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Wei D, Zhu H, He J, Bao T, Bi L. Introduction and preliminary application report for a novel 3D printed perforator navigator for fibular flap surgery. J Craniomaxillofac Surg 2024; 52:23-29. [PMID: 38129182 DOI: 10.1016/j.jcms.2023.11.004] [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] [Received: 07/25/2023] [Revised: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The aim of this study was to introduce and report on a 3D-printed perforator navigator and its clinical application. Integrated imaging and 3D printing techniques were employed for the design and manufacture of a perforator navigator. Key techniques included establishing a digital image coordinate system, localizing perforator fascia piercing points, creating a reference plane for the perforator course, and projecting the perforator course onto the body surface. All cases of maxillofacial defect repaired with free fibular myocutaneous flaps, from January 2019 to January 2022, were reinvestigated. Patients treated using traditional perforator localization methods were assigned into group Ⅰ, while those who had a navigator used during treatment were allocated to group Ⅱ. Outcome measurements included perforator positioning accuracy, perforator preparation time (PT), and flap growth score. Capillary refilling time and degree of flap swelling were recorded on the 1st, 3rd, and 7th days after surgery. On the 10th day after surgery, the flap survival situation was graded. In total, 25 patients were included in the study. Perforator preparation time for group Ⅱ was significantly less (p = 0.04) than for group Ⅰ (1038.6 ± 195.4 s versus 1271.4 ± 295.1 s. In group Ⅱ, the mean positioning deviation for the perforator navigator was 2.12 cm less than that for the high-frequency color Doppler (p = 0.001). Group Ⅱ also had a higher score than group Ⅰ for overall flap growth evaluation (nonparametric rank sum test, p = 0.04). Within the scale of the study, it seems that perforator localization and navigation using a 3D-printed navigator is technically feasible, and helps to improve the clinical outcome of free fibular flaps. The perforator navigator will play a useful role in displaying the perforator course, improving the accuracy of perforator localization, reducing surgical injury, and ultimately enhancing flap success rate.
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Affiliation(s)
- Dong Wei
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, PR China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, PR China
| | - Jianfeng He
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, PR China
| | - Tingwei Bao
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, PR China
| | - Ling Bi
- Department of Stomatology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province, PR China.
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Li C, Ji A, Jian Z, Zheng Y, Feng X, Guo W, Lerut T, Lin J, Li H. Augmented reality navigation-guided intraoperative pulmonary nodule localization: a pilot study. Transl Lung Cancer Res 2023; 12:1728-1737. [PMID: 37691871 PMCID: PMC10483087 DOI: 10.21037/tlcr-23-201] [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: 03/19/2023] [Accepted: 07/20/2023] [Indexed: 09/12/2023]
Abstract
Background With the increasing number of small pulmonary nodules detected, effective localization of pulmonary nodules has become an issue. The goal of this study is to determine the safety and feasibility of a newly developed augmented reality navigation technology for intraoperative localization of small pulmonary nodules. Methods We conducted a prospective single-center feasibility study of a novel augmented reality navigation system and lung localization (LungBrella) marker on ten patients between July and October 2020. For augmented reality navigation-guided localization, a preoperative chest computed tomography scan was performed to generate 3-dimensional (3D) virtual images and individualized localization plan, which were uploaded into Hololens (a head-mounted augmented reality device). Under the guidance of established procedure plan displayed by HoloLens, localization marker was placed in operating room. Segmentectomy or wedge resection was subsequently performed. The primary endpoint was the localization procedure success rate, and the secondary endpoints were localization time, operation time, and complications. Results Localization was successful in seven of the ten procedures. Due to different reasons, failures were noted in three cases, after which immediate adjustments were made. In the successful cases, the LungBrella marker was positioned at a median of 5.8 mm (range, 0-10 mm) from the edge of the nodule. Median localization time was 9.4 min (range, 5-19 min), and median operation time was 172.9 min (range, 105-200 min). There were no complications during the entire process. Conclusions This exploratory study suggests that augmented reality navigation-guided pulmonary nodule localization is a safe and feasible technique (ClinicalTrials.gov identifier, NCT04211051).
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Affiliation(s)
- Chengqiang Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anqi Ji
- Department of Thoracic Surgery, Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Zheng Jian
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yuyan Zheng
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xijia Feng
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Guo
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
| | - Jules Lin
- Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Luo B, Ren H, Wang Y, Ma L, Yu M, Ma Y, Yin L, Huang Y. Analysis of risk factors of pituitary neoplasms invading the sphenoidal sinus. Medicine (Baltimore) 2023; 102:e34767. [PMID: 37565869 PMCID: PMC10419706 DOI: 10.1097/md.0000000000034767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
High-resolution computed tomography (HR-CT) can more effectively discern the relationship between pituitary neoplasms (PNs) and neighboring anatomical structures. Moreover, pathological features can facilitate a more accurate determination of the growth pattern of PNs. Consequently, integrating imaging and pathological data might enhance our predictive capability regarding the growth patterns of PNs and aid in the formulation of surgical plans. We compared HR-CT images of 54 patients and 52 volunteers. Using ITK-SNAP software, we segmented and reconstructed the anatomical features of the sphenoidal sinus (SS) and calculated its volume. A comparative analysis of the invasive attributes of the 54 PNs was carried out based on clinical features and pathological data. The average volume of the SS in the volunteer group was 11.05 (8.10) mL, significantly larger than that of the PNs group at 7.45 (4.88) mL (P = .005). The postsellar type was the most common pneumatization type, and a significantly higher proportion in the PNs group exhibited a depressed saddle base (83.3%). A notable male predominance was observed for SS invasion in the PNs group (72.7%), with the Ki-67 antigen and maximum diameter significantly higher (P < .05), showing a positive correlation. The optimal cutoff points for Ki-67 antigen and the maximum diameter of PNs were 3.25% (AUC = 0.754, Sensitivity 54.5%, Specificity 90.6%) and 24.5 mm (AUC = 0.854, Sensitivity 86.4%, Specificity 78.1%), respectively. The type of pneumatization and the morphology of the sellar-floor serve as anatomical foundations for SS invasion. Factors such as the Ki-67 antigen, the maximum diameter of PNs, and high-risk sub-types constitute risk factors for PNs invasion into the SS. These insights are of significant utility for clinicians in crafting treatment strategies for PNs.
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Affiliation(s)
- Bin Luo
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Hecheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Yubo Wang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Lin Ma
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - MingSheng Yu
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - YuXiang Ma
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Long Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Ying Huang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
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Gsaxner C, Li J, Pepe A, Jin Y, Kleesiek J, Schmalstieg D, Egger J. The HoloLens in medicine: A systematic review and taxonomy. Med Image Anal 2023; 85:102757. [PMID: 36706637 DOI: 10.1016/j.media.2023.102757] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
The HoloLens (Microsoft Corp., Redmond, WA), a head-worn, optically see-through augmented reality (AR) display, is the main player in the recent boost in medical AR research. In this systematic review, we provide a comprehensive overview of the usage of the first-generation HoloLens within the medical domain, from its release in March 2016, until the year of 2021. We identified 217 relevant publications through a systematic search of the PubMed, Scopus, IEEE Xplore and SpringerLink databases. We propose a new taxonomy including use case, technical methodology for registration and tracking, data sources, visualization as well as validation and evaluation, and analyze the retrieved publications accordingly. We find that the bulk of research focuses on supporting physicians during interventions, where the HoloLens is promising for procedures usually performed without image guidance. However, the consensus is that accuracy and reliability are still too low to replace conventional guidance systems. Medical students are the second most common target group, where AR-enhanced medical simulators emerge as a promising technology. While concerns about human-computer interactions, usability and perception are frequently mentioned, hardly any concepts to overcome these issues have been proposed. Instead, registration and tracking lie at the core of most reviewed publications, nevertheless only few of them propose innovative concepts in this direction. Finally, we find that the validation of HoloLens applications suffers from a lack of standardized and rigorous evaluation protocols. We hope that this review can advance medical AR research by identifying gaps in the current literature, to pave the way for novel, innovative directions and translation into the medical routine.
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Affiliation(s)
- Christina Gsaxner
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria; BioTechMed, 8010 Graz, Austria.
| | - Jianning Li
- Institute of AI in Medicine, University Medicine Essen, 45131 Essen, Germany; Cancer Research Center Cologne Essen, University Medicine Essen, 45147 Essen, Germany
| | - Antonio Pepe
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria; BioTechMed, 8010 Graz, Austria
| | - Yuan Jin
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria; Research Center for Connected Healthcare Big Data, Zhejiang Lab, Hangzhou, 311121 Zhejiang, China
| | - Jens Kleesiek
- Institute of AI in Medicine, University Medicine Essen, 45131 Essen, Germany; Cancer Research Center Cologne Essen, University Medicine Essen, 45147 Essen, Germany
| | - Dieter Schmalstieg
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria; BioTechMed, 8010 Graz, Austria
| | - Jan Egger
- Institute of Computer Graphics and Vision, Graz University of Technology, 8010 Graz, Austria; Institute of AI in Medicine, University Medicine Essen, 45131 Essen, Germany; BioTechMed, 8010 Graz, Austria; Cancer Research Center Cologne Essen, University Medicine Essen, 45147 Essen, Germany
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Baashar Y, Alkawsi G, Wan Ahmad WN, Alomari MA, Alhussian H, Tiong SK. Towards Wearable Augmented Reality in Healthcare: A Comparative Survey and Analysis of Head-Mounted Displays. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3940. [PMID: 36900951 PMCID: PMC10002206 DOI: 10.3390/ijerph20053940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Head-mounted displays (HMDs) have the potential to greatly impact the surgical field by maintaining sterile conditions in healthcare environments. Google Glass (GG) and Microsoft HoloLens (MH) are examples of optical HMDs. In this comparative survey related to wearable augmented reality (AR) technology in the medical field, we examine the current developments in wearable AR technology, as well as the medical aspects, with a specific emphasis on smart glasses and HoloLens. The authors searched recent articles (between 2017 and 2022) in the PubMed, Web of Science, Scopus, and ScienceDirect databases and a total of 37 relevant studies were considered for this analysis. The selected studies were divided into two main groups; 15 of the studies (around 41%) focused on smart glasses (e.g., Google Glass) and 22 (59%) focused on Microsoft HoloLens. Google Glass was used in various surgical specialities and preoperative settings, namely dermatology visits and nursing skill training. Moreover, Microsoft HoloLens was used in telepresence applications and holographic navigation of shoulder and gait impairment rehabilitation, among others. However, some limitations were associated with their use, such as low battery life, limited memory size, and possible ocular pain. Promising results were obtained by different studies regarding the feasibility, usability, and acceptability of using both Google Glass and Microsoft HoloLens in patient-centric settings as well as medical education and training. Further work and development of rigorous research designs are required to evaluate the efficacy and cost-effectiveness of wearable AR devices in the future.
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Affiliation(s)
- Yahia Baashar
- Faculty of Computing and Informatics, Universiti Malaysia Sabah (UMS), Labuan 87000, Malaysia
| | - Gamal Alkawsi
- Institute of Sustainable Energy (ISE), Universiti Tenaga Nasional, Kajang 43000, Malaysia
- Faculty of Computer Science and Information Systems, Thamar University, Thamar 87246, Yemen
| | | | - Mohammad Ahmed Alomari
- Institute of Informatics and Computing in Energy, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | - Hitham Alhussian
- Department of Computer and Information Sciences, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia
| | - Sieh Kiong Tiong
- Institute of Sustainable Energy (ISE), Universiti Tenaga Nasional, Kajang 43000, Malaysia
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Ma L, Huang T, Wang J, Liao H. Visualization, registration and tracking techniques for augmented reality guided surgery: a review. Phys Med Biol 2023; 68. [PMID: 36580681 DOI: 10.1088/1361-6560/acaf23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
Augmented reality (AR) surgical navigation has developed rapidly in recent years. This paper reviews and analyzes the visualization, registration, and tracking techniques used in AR surgical navigation systems, as well as the application of these AR systems in different surgical fields. The types of AR visualization are divided into two categories ofin situvisualization and nonin situvisualization. The rendering contents of AR visualization are various. The registration methods include manual registration, point-based registration, surface registration, marker-based registration, and calibration-based registration. The tracking methods consist of self-localization, tracking with integrated cameras, external tracking, and hybrid tracking. Moreover, we describe the applications of AR in surgical fields. However, most AR applications were evaluated through model experiments and animal experiments, and there are relatively few clinical experiments, indicating that the current AR navigation methods are still in the early stage of development. Finally, we summarize the contributions and challenges of AR in the surgical fields, as well as the future development trend. Despite the fact that AR-guided surgery has not yet reached clinical maturity, we believe that if the current development trend continues, it will soon reveal its clinical utility.
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Affiliation(s)
- Longfei Ma
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Tianqi Huang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Jie Wang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
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Chegini S, Edwards E, McGurk M, Clarkson M, Schilling C. Systematic review of techniques used to validate the registration of augmented-reality images using a head-mounted device to navigate surgery. Br J Oral Maxillofac Surg 2023; 61:19-27. [PMID: 36513525 DOI: 10.1016/j.bjoms.2022.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/31/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
Augmented-reality (AR) head-mounted devices (HMD) allow the wearer to have digital images superposed on to their field of vision. They are being used to superpose annotations on to the surgical field akin to a navigation system. This review examines published validation studies on HMD-AR systems, their reported protocols, and outcomes. The aim was to establish commonalities and an acceptable registration outcome. Multiple databases were systematically searched for relevant articles between January 2015 and January 2021. Studies that examined the registration of AR content using a HMD to guide surgery were eligible for inclusion. The country of origin, year of publication, medical specialty, HMD device, software, and method of registration, were recorded. A meta-analysis of the mean registration error was conducted. A total of 4784 papers were identified, of which 23 met the inclusion criteria. They included studies using HoloLens (Microsoft) (n = 22) and nVisor ST60 (NVIS Inc) (n = 1). Sixty-six per cent of studies were in hard tissue specialties. Eleven studies reported registration errors using pattern markers (mean (SD) 2.6 (1.8) mm), and four reported registration errors using surface markers (mean (SD) 3.8 (3.7) mm). Three studies reported registration errors using manual alignment (mean (SD) 2.2 (1.3) mm). The majority of studies in this review used in-house software with a variety of registration methods and reported errors. The mean registration error calculated in this study can be considered as a minimum acceptable standard. It should be taken into consideration when procedural applications are selected.
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Affiliation(s)
- Soudeh Chegini
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom.
| | - Eddie Edwards
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Mark McGurk
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Matthew Clarkson
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
| | - Clare Schilling
- University College London, Charles Bell House, 43-45 Foley St, London W1W 7TY, United Kingdom
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Tang Y, Guo Q, Li X, Huang Y, Kuang W, Luo L. Augmented reality-assisted systematic mapping of anterolateral thigh perforators. BMC Musculoskelet Disord 2022; 23:1047. [PMID: 36457082 PMCID: PMC9716696 DOI: 10.1186/s12891-022-06013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE In soft tissue reconstructive surgery, perforator localization and flap harvesting have always been critical challenges, but augmented reality (AR) has become a dominant technology to help map perforators. METHODS The lateral circumflex femoral artery (LCFA) and its perforators were reconstructed by CTA in consecutive patients (N = 14). Then, the anterolateral thigh perforators and the points from which the perforators emerged from the deep fascia were marked and projected onto the skin surface. As the virtual images were projected onto patients according to bony markers, the courses of the LCFA and its perforators were depicted on the skin surface for intraoperative guidance. Finally, the locations of the emergence points were verified by intraoperative findings and compared to those determined by handheld Doppler ultrasound. RESULTS The sources, locations, and numbers of perforators were determined by CTA. The perforators and their emergence points were accurately mapped on the skin surface by a portable projector to harvest the anterolateral thigh perforator flap. During the operation, the accuracy of the CTA & AR method was 90.2% (37/41), and the sensitivity reached 97.4% (37/38), which were much higher than the corresponding values of Doppler ultrasound. Additionally, the differences between the AR-marked points and the intraoperative findings were much smaller than those seen with Doppler ultrasound (P < 0.001). Consequently, all of the flaps were well designed and survived, and only one complication occurred. CONCLUSION Augmented reality, namely, CTA combined with projection in this study, plays a vital and reliable role in locating the perforator emergence points and guiding the procedure to harvest flaps and has fewer potential risks.
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Affiliation(s)
- Yifu Tang
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
| | - Qiang Guo
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
| | - Xiaoning Li
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
| | - Yuzhao Huang
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
| | - Wei Kuang
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
| | - Ling Luo
- grid.216417.70000 0001 0379 7164Department of Orthopaedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road Changsha, Hunan, China
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11
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Hatzl J, Böckler D, Meisenbacher K, Barb A, Hartmann N, Henning D, Uhl C. Mixed Reality in der Gefäßchirurgie – ein Scoping Review. Zentralbl Chir 2022; 147:439-446. [DOI: 10.1055/a-1939-7686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Zusammenfassung
Hintergrund „Mixed Reality“ (MR) erlaubt die Projektion von virtuellen Objekten in das Sichtfeld des Anwenders durch ein Head-mounted Display (HMD). Im gefäßchirurgischen
Behandlungsspektrum könnten MR-Anwendungen in Zukunft einen Nutzen darstellen. Im folgenden Scoping Review soll eine Orientierung über die aktuelle Anwendung der genannten Technologien im
Bereich der Gefäßchirurgie gegeben und Forschungsziele für die Zukunft definiert werden. Material und Methoden Es erfolgte eine systematische Literaturrecherche in PubMed (MEDLINE)
mit den Suchbegriffen „aorta“, „intervention“, „endovsacular intervention“, „vascular surgery“, „aneurysm“, „endovascular“, „vascular access“ jeweils in Kombination mit „mixed reality“ oder
„augmented reality“. Die Suche erfolgte nach PRISMA-Leitlinie (Preferred Reporting Items for Systematic reviews and Meta-Analyses) für Scoping Reviews. Ergebnisse Aus 547
Literaturstellen konnten 8 relevante Studien identifiziert werden. Die Suchergebnisse konnten in 2 Anwendungskategorien eingeteilt werden: (1) MR mit dem Ziel des Informationsmanagements und
zur Verbesserung der periprozeduralen Ergonomie gefäßchirurgischer Eingriffe (n = 3) sowie (2) MR mit dem Ziel der intraoperativen Navigation bei gefäßchirurgischen Eingriffen (n = 5). Die
Registrierung des physischen Patienten mit dem virtuellen Objekt und das Tracking von Instrumenten in der MR-Umgebung zur intraoperativen Navigation ist dabei im Fokus des wissenschaftlichen
Interesses und konnte technisch erfolgreich am Phantom- und Tiermodell gezeigt werden. Die bisher vorgestellten Methoden sind jedoch mit hohem infrastrukturellem Aufwand und relevanten
Limitationen verbunden. Schlussfolgerung Der Einsatz von MR im Bereich der Gefäßchirurgie ist grundsätzlich vielversprechend. Für die Zukunft sollten alternative, pragmatische
Registrierungsmethoden mit entsprechender Quantifizierung des Positionierungsfehlers angestrebt werden. Die entwickelten Soft- und Hardwarelösungen sollten auf das Anforderungsprofil der
Gefäßchirurgie angepasst werden. Das elektromagnetische Instrumenten-Tracking erscheint als sinnvolle, komplementäre Technologie zur Umsetzung der MR-assistierten Navigation.
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Affiliation(s)
- Johannes Hatzl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Dittmar Böckler
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Katrin Meisenbacher
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Alexandru Barb
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Niklas Hartmann
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Daniel Henning
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Christian Uhl
- Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
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12
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Multicenter assessment of augmented reality registration methods for image-guided interventions. Radiol Med 2022; 127:857-865. [DOI: 10.1007/s11547-022-01515-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
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13
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Abstract
Augmented reality (AR) is an innovative system that enhances the real world by superimposing virtual objects on reality. The aim of this study was to analyze the application of AR in medicine and which of its technical solutions are the most used. We carried out a scoping review of the articles published between 2019 and February 2022. The initial search yielded a total of 2649 articles. After applying filters, removing duplicates and screening, we included 34 articles in our analysis. The analysis of the articles highlighted that AR has been traditionally and mainly used in orthopedics in addition to maxillofacial surgery and oncology. Regarding the display application in AR, the Microsoft HoloLens Optical Viewer is the most used method. Moreover, for the tracking and registration phases, the marker-based method with a rigid registration remains the most used system. Overall, the results of this study suggested that AR is an innovative technology with numerous advantages, finding applications in several new surgery domains. Considering the available data, it is not possible to clearly identify all the fields of application and the best technologies regarding AR.
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14
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Kamiya K, Matsubayashi Y, Terada S, Nagatani Y, Fujii T, Nakata S, Suzuki T. Ex-vivo aortic root and coronary artery cast measurement to validate the accuracy of virtual imaging. J Card Surg 2022; 37:2461-2465. [PMID: 35502466 DOI: 10.1111/jocs.16559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/03/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY To investigate the accuracy of two methods of measuring features in cardiac anatomy, using an objective standard cast model. METHODS We made a silicone cast using a swine heart. Computerized tomography data of the solidified cast were processed through virtual reality (VR) software and through two-dimensional multiplanar-reconstruction (2D-MPR), and all measurements were compared against physical measurements of the cast. RESULTS The cast perfectly demonstrated the fine detail of the aortic valve and the proximal parts of coronary arteries. Anatomical features were measured by 3D-VR, 2D-MPR, and directly on the cast. Measurement differences between 2D-MPR and the cast were on average at least 3.6 times larger than those between 3D-VR and the cast. CONCLUSIONS Based on the observed accuracy, 3D-VR measurements seem considerably more accurate than the current standard 2D-MPR, and 3D-VR may be considered as the next gold standard for 3D measurement of cardiac anatomy in vivo.
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Affiliation(s)
- Kenichi Kamiya
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.,Graduate School of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.,Research Organization of Science and Technology, Ritsumeikan University, Otsu, Shiga, Japan
| | - Yuji Matsubayashi
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinya Terada
- Graduate School of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Taihei Fujii
- Research Organization of Science and Technology, Ritsumeikan University, Otsu, Shiga, Japan
| | - Susumu Nakata
- College of Information Science and Engineering, Ritsumeikan University, Otsu, Shiga, Japan
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan
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15
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Howard MC, Davis MM. A meta-analysis and systematic literature review of mixed reality rehabilitation programs: Investigating design characteristics of augmented reality and augmented virtuality. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Abstract
Ophthalmology is a medical profession with a tradition in teaching that has developed throughout history. Although ophthalmologists are generally considered to only prescribe contact lenses, and they handle more than half of eye-related enhancements, diagnoses, and treatments. The training of qualified ophthalmologists is generally carried out under the traditional settings, where there is a supervisor and a student, and training is based on the use of animal eyes or artificial eye models. These models have significant disadvantages, as they are not immersive and are extremely expensive and difficult to acquire. Therefore, technologies related to Augmented Reality (AR) and Virtual Reality (VR) are rapidly and prominently positioning themselves in the medical sector, and the field of ophthalmology is growing exponentially both in terms of the training of professionals and in the assistance and recovery of patients. At the same time, it is necessary to highlight and analyze the developments that have made use of game technologies for the teaching of ophthalmology and the results that have been obtained. This systematic review aims to investigate software and hardware applications developed exclusively for educational environments related to ophthalmology and provide an analysis of other related tools. In addition, the advantages and disadvantages, limitations, and challenges involved in the use of virtual reality, augmented reality, and game technologies in this field are also presented.
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17
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Birlo M, Edwards PJE, Clarkson M, Stoyanov D. Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review. Med Image Anal 2022; 77:102361. [PMID: 35168103 PMCID: PMC10466024 DOI: 10.1016/j.media.2022.102361] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/17/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
This article presents a systematic review of optical see-through head mounted display (OST-HMD) usage in augmented reality (AR) surgery applications from 2013 to 2020. Articles were categorised by: OST-HMD device, surgical speciality, surgical application context, visualisation content, experimental design and evaluation, accuracy and human factors of human-computer interaction. 91 articles fulfilled all inclusion criteria. Some clear trends emerge. The Microsoft HoloLens increasingly dominates the field, with orthopaedic surgery being the most popular application (28.6%). By far the most common surgical context is surgical guidance (n=58) and segmented preoperative models dominate visualisation (n=40). Experiments mainly involve phantoms (n=43) or system setup (n=21), with patient case studies ranking third (n=19), reflecting the comparative infancy of the field. Experiments cover issues from registration to perception with very different accuracy results. Human factors emerge as significant to OST-HMD utility. Some factors are addressed by the systems proposed, such as attention shift away from the surgical site and mental mapping of 2D images to 3D patient anatomy. Other persistent human factors remain or are caused by OST-HMD solutions, including ease of use, comfort and spatial perception issues. The significant upward trend in published articles is clear, but such devices are not yet established in the operating room and clinical studies showing benefit are lacking. A focused effort addressing technical registration and perceptual factors in the lab coupled with design that incorporates human factors considerations to solve clear clinical problems should ensure that the significant current research efforts will succeed.
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Affiliation(s)
- Manuel Birlo
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK.
| | - P J Eddie Edwards
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Matthew Clarkson
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TS, UK
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Kiraly L, Shah NC, Abdullah O, Al-Ketan O, Rowshan R. Three-Dimensional Virtual and Printed Prototypes in Complex Congenital and Pediatric Cardiac Surgery-A Multidisciplinary Team-Learning Experience. Biomolecules 2021; 11:1703. [PMID: 34827702 PMCID: PMC8615737 DOI: 10.3390/biom11111703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022] Open
Abstract
Three-dimensional (3D) virtual modeling and printing advances individualized medicine and surgery. In congenital cardiac surgery, 3D virtual models and printed prototypes offer advantages of better understanding of complex anatomy, hands-on preoperative surgical planning and emulation, and improved communication within the multidisciplinary team and to patients. We report our single center team-learning experience about the realization and validation of possible clinical benefits of 3D-printed models in surgical planning of complex congenital cardiac surgery. CT-angiography raw data were segmented into 3D-virtual models of the heart-great vessels. Prototypes were 3D-printed as rigid "blood-volume" and flexible "hollow". The accuracy of the models was evaluated intraoperatively. Production steps were realized in the framework of a clinical/research partnership. We produced 3D prototypes of the heart-great vessels for 15 case scenarios (nine males, median age: 11 months) undergoing complex intracardiac repairs. Parity between 3D models and intraoperative structures was within 1 mm range. Models refined diagnostics in 13/15, provided new anatomic information in 9/15. As a team-learning experience, all complex staged redo-operations (13/15; Aristotle-score mean: 10.64 ± 1.95) were rehearsed on the 3D models preoperatively. 3D-printed prototypes significantly contributed to an improved/alternative operative plan on the surgical approach, modification of intracardiac repair in 13/15. No operative morbidity/mortality occurred. Our clinical/research partnership provided coverage for the extra time/labor and material/machinery not financed by insurance. 3D-printed models provided a team-learning experience and contributed to the safety of complex congenital cardiac surgeries. A clinical/research partnership may open avenues for bioprinting of patient-specific implants.
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Affiliation(s)
- Laszlo Kiraly
- Division of Pediatric Cardiac Surgery, Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi P.O. Box 51900, United Arab Emirates
- Department of Public Health, Semmelweis University, H-1085 Budapest, Hungary
- Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital System, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore 119228, Singapore
| | - Nishant C. Shah
- Division of Pediatric Cardiology, Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi P.O. Box 51900, United Arab Emirates;
| | - Osama Abdullah
- Core Technology Platform Operations, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (O.A.); (O.A.-K.); (R.R.)
| | - Oraib Al-Ketan
- Core Technology Platform Operations, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (O.A.); (O.A.-K.); (R.R.)
| | - Reza Rowshan
- Core Technology Platform Operations, New York University Abu Dhabi, Abu Dhabi P.O. Box 129188, United Arab Emirates; (O.A.); (O.A.-K.); (R.R.)
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Ong CW, Tan MCJ, Lam M, Koh VTC. Applications of Extended Reality in Ophthalmology: Systematic Review. J Med Internet Res 2021; 23:e24152. [PMID: 34420929 PMCID: PMC8414293 DOI: 10.2196/24152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/19/2020] [Accepted: 04/06/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Virtual reality, augmented reality, and mixed reality make use of a variety of different software and hardware, but they share three main characteristics: immersion, presence, and interaction. The umbrella term for technologies with these characteristics is extended reality. The ability of extended reality to create environments that are otherwise impossible in the real world has practical implications in the medical discipline. In ophthalmology, virtual reality simulators have become increasingly popular as tools for surgical education. Recent developments have also explored diagnostic and therapeutic uses in ophthalmology. OBJECTIVE This systematic review aims to identify and investigate the utility of extended reality in ophthalmic education, diagnostics, and therapeutics. METHODS A literature search was conducted using PubMed, Embase, and Cochrane Register of Controlled Trials. Publications from January 1, 1956 to April 15, 2020 were included. Inclusion criteria were studies evaluating the use of extended reality in ophthalmic education, diagnostics, and therapeutics. Eligible studies were evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Relevant studies were also evaluated using a validity framework. Findings and relevant data from the studies were extracted, evaluated, and compared to determine the utility of extended reality in ophthalmology. RESULTS We identified 12,490 unique records in our literature search; 87 met final eligibility criteria, comprising studies that evaluated the use of extended reality in education (n=54), diagnostics (n=5), and therapeutics (n=28). Of these, 79 studies (91%) achieved evidence levels in the range 2b to 4, indicating poor quality. Only 2 (9%) out of 22 relevant studies addressed all 5 sources of validity evidence. In education, we found that ophthalmic surgical simulators demonstrated efficacy and validity in improving surgical performance and reducing complication rates. Ophthalmoscopy simulators demonstrated efficacy and validity evidence in improving ophthalmoscopy skills in the clinical setting. In diagnostics, studies demonstrated proof-of-concept in presenting ocular imaging data on extended reality platforms and validity in assessing the function of patients with ophthalmic diseases. In therapeutics, heads-up surgical systems had similar complication rates, procedural success rates, and outcomes in comparison with conventional ophthalmic surgery. CONCLUSIONS Extended reality has promising areas of application in ophthalmology, but additional high-quality comparative studies are needed to assess their roles among incumbent methods of ophthalmic education, diagnostics, and therapeutics.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marcus Chun Jin Tan
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Michael Lam
- Department of Ophthalmology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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20
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Review of Microsoft HoloLens Applications over the Past Five Years. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167259] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since Microsoft HoloLens first appeared in 2016, HoloLens has been used in various industries, over the past five years. This study aims to review academic papers on the applications of HoloLens in several industries. A review was performed to summarize the results of 44 papers (dated between January 2016 and December 2020) and to outline the research trends of applying HoloLens to different industries. This study determined that HoloLens is employed in medical and surgical aids and systems, medical education and simulation, industrial engineering, architecture, civil engineering and other engineering fields. The findings of this study contribute towards classifying the current uses of HoloLens in various industries and identifying the types of visualization techniques and functions.
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21
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Lareyre F, Chaudhuri A, Adam C, Carrier M, Mialhe C, Raffort J. Applications of Head-Mounted Displays and Smart Glasses in Vascular Surgery. Ann Vasc Surg 2021; 75:497-512. [PMID: 33823254 DOI: 10.1016/j.avsg.2021.02.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Advances in virtual, augmented and mixed reality have led to the development of wearable technologies including head mounted displays (HMD) and smart glasses. While there is a growing interest on their potential applications in health, only a few studies have addressed so far their use in vascular surgery. The aim of this review was to summarize the fundamental notions associated with these technologies and to discuss potential applications and current limits for their use in vascular surgery. METHODS A comprehensive literature review was performed to introduce the fundamental concepts and provide an overview of applications of HMD and smart glasses in surgery. RESULTS HMD and smart glasses demonstrated a potential interest for the education of surgeons including anatomical teaching, surgical training, teaching and telementoring. Applications for pre-surgical planning have been developed in general and cardiac surgery and could be transposed for a use in vascular surgery. The use of wearable technologies in the operating room has also been investigated in both general and cardiovascular surgery and demonstrated its potential interest for image-guided surgery and data collection. CONCLUSION Studies performed so far represent a proof of concept of the interest of HMD and smart glasses in vascular surgery for education of surgeons and for surgical practice. Although these technologies exhibited encouraging results for applications in vascular surgery, technical improvements and further clinical research in large series are required before hoping using them in daily clinical practice.
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Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes-Juan-les-Pins, France; Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France.
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Cédric Adam
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, France
| | - Marion Carrier
- Laboratory of Applied Mathematics and Computer Science (MICS), CentraleSupélec, Université Paris-Saclay, France
| | - Claude Mialhe
- Cardiovascular Surgery Unit, Cardio Thoracic Centre of Monaco, Monaco
| | - Juliette Raffort
- Université Côte d'Azur, CHU, Inserm U1065, C3M, Nice, France; Clinical Chemistry Laboratory, University Hospital of Nice, France
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22
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Andrews CM, Henry AB, Soriano IM, Southworth MK, Silva JR. Registration Techniques for Clinical Applications of Three-Dimensional Augmented Reality Devices. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2020; 9:4900214. [PMID: 33489483 PMCID: PMC7819530 DOI: 10.1109/jtehm.2020.3045642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/13/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Many clinical procedures would benefit from direct and intuitive real-time visualization of anatomy, surgical plans, or other information crucial to the procedure. Three-dimensional augmented reality (3D-AR) is an emerging technology that has the potential to assist physicians with spatial reasoning during clinical interventions. The most intriguing applications of 3D-AR involve visualizations of anatomy or surgical plans that appear directly on the patient. However, commercially available 3D-AR devices have spatial localization errors that are too large for many clinical procedures. For this reason, a variety of approaches for improving 3D-AR registration accuracy have been explored. The focus of this review is on the methods, accuracy, and clinical applications of registering 3D-AR devices with the clinical environment. The works cited represent a variety of approaches for registering holograms to patients, including manual registration, computer vision-based registration, and registrations that incorporate external tracking systems. Evaluations of user accuracy when performing clinically relevant tasks suggest that accuracies of approximately 2 mm are feasible. 3D-AR device limitations due to the vergence-accommodation conflict or other factors attributable to the headset hardware add on the order of 1.5 mm of error compared to conventional guidance. Continued improvements to 3D-AR hardware will decrease these sources of error.
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Affiliation(s)
- Christopher M. Andrews
- Department of Biomedical EngineeringWashington University in St Louis, McKelvey School of EngineeringSt LouisMO63130USA
- SentiAR, Inc.St. LouisMO63108USA
| | | | | | | | - Jonathan R. Silva
- Department of Biomedical EngineeringWashington University in St Louis, McKelvey School of EngineeringSt LouisMO63130USA
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23
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Kumar RP, Pelanis E, Bugge R, Brun H, Palomar R, Aghayan DL, Fretland ÅA, Edwin B, Elle OJ. Use of mixed reality for surgery planning: Assessment and development workflow. J Biomed Inform 2020; 112S:100077. [PMID: 34417006 DOI: 10.1016/j.yjbinx.2020.100077] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/09/2020] [Accepted: 08/16/2020] [Indexed: 12/15/2022]
Abstract
Meticulous preoperative planning is an important part of any surgery to achieve high levels of precision and avoid complications. Conventional medical 2D images and their corresponding three-dimensional (3D) reconstructions are the main components of an efficient planning system. However, these systems still use flat screens for visualisation of 3D information, thus losing depth information which is crucial for 3D spatial understanding. Currently, cutting-edge mixed reality systems have shown to be a worthy alternative to provide 3D information to clinicians. In this work, we describe development details of the different steps in the workflow for the clinical use of mixed reality, including results from a qualitative user evaluation and clinical use-cases in laparoscopic liver surgery and heart surgery. Our findings indicate a very high general acceptance of mixed reality devices with our applications and they were consistently rated high for device, visualisation and interaction areas in our questionnaire. Furthermore, our clinical use-cases demonstrate that the surgeons perceived the HoloLens to be useful, recommendable to other surgeons and also provided a definitive answer at a multi-disciplinary team meeting.
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Affiliation(s)
- Rahul Prasanna Kumar
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway.
| | - Egidijus Pelanis
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway
| | - Robin Bugge
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Diagnostic Physics, Oslo University Hospital, Sognsvannsvn 20, 0372 Oslo, Norway
| | - Henrik Brun
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Department for Pediatric Cardiology, Oslo University Hospital, Sognsvannsvn 20, 0372 Oslo, Norway
| | - Rafael Palomar
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Computer Science, NTNU, Teknologiveien 22, 2815 Gjøvik, Norway
| | - Davit L Aghayan
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Surgery N1, Yerevan State Medical University, Yerevan, Armenia
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; Department of Hepatopancreatobiliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Ole Jakob Elle
- The Intervention Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Department of Informatics, University of Oslo, Gaustadallèen 23 B, 0373 Oslo, Norway
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