Augmented Reality and Intraoperative Navigation in Sinonasal Malignancies: A Preclinical Study

Abstract

ObjectiveTo report the first use of a novel projected augmented reality (AR) system in open sinonasal tumor resections in preclinical models and to compare the AR approach with an advanced intraoperative navigation (IN) system.MethodsFour tumor models were created. Five head and neck surgeons participated in the study performing virtual osteotomies. Unguided, AR, IN, and AR + IN simulations were performed. Statistical comparisons between approaches were obtained. Intratumoral cut rate was the main outcome. The groups were also compared in terms of percentage of intratumoral, close, adequate, and excessive distances from the tumor. Information on a wearable gaze tracker headset and NASA Task Load Index questionnaire results were analyzed as well.ResultsA total of 335 cuts were simulated. Intratumoral cuts were observed in 20.7%, 9.4%, 1.2,% and 0% of the unguided, AR, IN, and AR + IN simulations, respectively (p < 0.0001). The AR was superior than the unguided approach in univariate and multivariate models. The percentage of time looking at the screen during the procedures was 55.5% for the unguided approaches and 0%, 78.5%, and 61.8% in AR, IN, and AR + IN, respectively (p < 0.001). The combined approach significantly reduced the screen time compared with the IN procedure alone.ConclusionWe reported the use of a novel AR system for oncological resections in open sinonasal approaches, with improved margin delineation compared with unguided techniques. AR improved the gaze-toggling drawback of IN. Further refinements of the AR system are needed before translating our experience to clinical practice.

Using augmented reality to guide bone conduction device implantation

“…Within the control arm, surgeons utilized Materialise Mimics’ built-in measurement tool for eventual intraoperative reference during implant placement. Whereas in the experimental arm, device placement was projected onto the surgical field using GTx-Eyes (Guided Therapeutics, TECHNA Institute, Canada) via a PicoPro projector (Cellon Inc., South Korea) 7 , 11 . The AR setup is demonstrated in Fig.…”

“…Surgical simulation software paired with intraoperative navigation (IN) tools have also been utilized 2 , 6 . A major challenge of IN technologies is the omission of relevant information from the surgical field requiring surgeons to switch their focus to and from the surgical field 7 . Augmented reality (AR) guided surgery has been proposed to overcome this by placing relevant information directly into the surgical field 8 .…”

Skull-Base Surgery—A Narrative Review on Current Approaches and Future Developments in Surgical Navigation

“…Sahovaler et al [ 105 ] reported a novel AR system in open sinonasal tumor resections in preclinical skull models and compared it to the more traditional intraoperative navigation systems. Using GTx-Eyes [ 81 ], tumors were projected by an external projector onto the skull surface.…”

Treatment of Skull Base Diseases: A Multidisciplinary Challenge

“…Rather, it represents a gateway to the critical structures located within the bone of the skull base, since most of the surgical approaches consist in drilling out the bone of the skull base until the target areas are reached. The recent development of virtual surgical planning protocols and image-guided surgery systems have rendered the “surgical corridor” paradigm even more crucial, thus supporting the accurate planning of the surgical trajectory towards the target area and facilitating the anatomical orientation [ 10 , 11 , 12 , 13 , 14 ]. In this setting, augmented reality visualization modalities may represent a new frontier in which to further improve the benefits provided by the image-guided surgery paradigm [ 12 , 13 , 15 ].…”

“…The recent development of virtual surgical planning protocols and image-guided surgery systems have rendered the “surgical corridor” paradigm even more crucial, thus supporting the accurate planning of the surgical trajectory towards the target area and facilitating the anatomical orientation [ 10 , 11 , 12 , 13 , 14 ]. In this setting, augmented reality visualization modalities may represent a new frontier in which to further improve the benefits provided by the image-guided surgery paradigm [ 12 , 13 , 15 ].…”