Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers

Abstract

Augmented reality (AR)-based surgical navigation may offer new possibilities for safe and accurate surgical execution of complex osteotomies. In this study we investigated the feasibility of navigating the periacetabular osteotomy of Ganz (PAO), known as one of the most complex orthopedic interventions, on two cadaveric pelves under realistic operating room conditions. Preoperative planning was conducted on computed tomography (CT)-reconstructed 3D models using an in-house developed software, which allowed creating cutting plane objects for planning of the osteotomies and reorientation of the acetabular fragment. An AR application was developed comprising point-based registration, motion compensation and guidance for osteotomies as well as fragment reorientation. Navigation accuracy was evaluated on CT-reconstructed 3D models, resulting in an error of 10.8 mm for osteotomy starting points and 5.4° for osteotomy directions. The reorientation errors were 6.7°, 7.0° and 0.9° for the x-, y- and z-axis, respectively. Average postoperative error of LCE angle was 4.5°. Our study demonstrated that the AR-based execution of complex osteotomies is feasible. Fragment realignment navigation needs further improvement, although it is more accurate than the state of the art in PAO surgery.

Augmenting Performance: A Systematic Review of Optical See-Through Head-Mounted Displays in Surgery

“…In Figure 8 , a breakdown of the 57 papers included in our survey is depicted based on their general surgical speciality. The majority of papers ( ) focused on orthopedic applications, such as osteotomy [ 45 , 46 , 47 , 48 , 49 ] and K-wire placement [ 50 , 51 ], with the second largest ( ) involving maxillofacial surgery procedures, such as tumor resection [ 52 ] and craniofacial fibrous dysplasia [ 53 , 54 ]. The prevalence of OST-HMD investigation in orthopedic and maxillofacial surgeries is likely due to the rigid nature of the relevant anatomy, the availability of consistent landmarks for registration and tracking, and the prevalence of commercially available surgical navigation suites.…”

“…As an evaluation platform, cadaver models are a step up from anthropomorphic phantoms in terms of anatomical realism; however, they do not require the same safety critical considerations as studies with patients. Cadaver models were used in the evaluation of navigation accuracy in complex pelvic osteotomies [ 45 ], assessment of performance during immersive telementoring [ 58 ], total shoulder arthroplasty [ 88 ], maxillofacial zygomatic arch reconstruction [ 85 ], and orthopedic K-Wire placement [ 50 ]. Animal models improve on the anatomical relevance of cadaver models due to the incorporation of realistic tissue deformation and real-time respiratory and cardiac motion.…”

“…We have also indicated the measured accuracy of the surveyed papers in Table 6 . Overall, the accuracy provided by an OST-HMD guidance system which is integrated with an existing surgical navigation suite has been demonstrated to be on the order of 2–5 mm [ 67 , 68 , 82 , 93 , 98 , 102 ], which is sufficient for certain surgical interventions, such as neurosurgical burr hole placement (<10 mm) [ 104 ] or complex pelvic osteotomies (<10 mm) [ 45 ]. As previously mentioned, the most popular tracking strategy for OST-HMD-camera-led surgical navigation relied on square-marker fiducials, such as ArUco [ 31 ] or Vuforia and monocular RGB video.…”

Augmented Reality as a Tool to Guide PSI Placement in Pelvic Tumor Resections

“…Studies focused on estimating the accuracy provided by these technologies are performed in a living subject [ 26 ], a cadaver [ 8 , 12 , 13 , 27 ], or a phantom [ 1 , 10 , 18 ]. Although phantoms provide a less realistic environment, they present several advantages apart from avoiding patient risks.…”

Evaluation of HMDs by QFD for Augmented Reality Applications in the Maxillofacial Surgery Domain

“…There is a rich body of literature about AR applications in different surgical specialities: AR-based surgical navigation offers new possibilities in complex orthopaedic osteotomies for a safer and more accurate execution [2]. The training of procedures as thoracoscopy, arthroplasty (and many other) is improved by the introduction of AR instruments [3,4].…”