Augmented reality in the operating room: a clinical feasibility study

Abstract

Background Augmented Reality (AR) is a rapidly emerging technology finding growing acceptance and application in different fields of surgery. Various studies have been performed evaluating the precision and accuracy of AR guided navigation. This study investigates the feasibility of a commercially available AR head mounted device during orthopedic surgery. Methods Thirteen orthopedic surgeons from a Swiss university clinic performed 25 orthopedic surgical procedures wearing a holographic AR headset (HoloLens, Microsoft, Redmond, WA, USA) providing complementary three-dimensional, patient specific anatomic information. The surgeon’s experience of using the device during surgery was recorded using a standardized 58-item questionnaire grading different aspects on a 100-point scale with anchor statements. Results Surgeons were generally satisfied with image quality (85 ± 17 points) and accuracy of the virtual objects (84 ± 19 point). Wearing the AR device was rated as fairly comfortable (79 ± 13 points). Functionality of voice commands (68 ± 20 points) and gestures (66 ± 20 points) provided less favorable results. The greatest potential in the use of the AR device was found for surgical correction of deformities (87 ± 15 points). Overall, surgeons were satisfied with the application of this novel technology (78 ± 20 points) and future access to it was demanded (75 ± 22 points). Conclusion AR is a rapidly evolving technology with large potential in different surgical settings, offering the opportunity to provide a compact, low cost alternative requiring a minimum of infrastructure compared to conventional navigation systems. While surgeons where generally satisfied with image quality of the here tested head mounted AR device, some technical and ergonomic shortcomings were pointed out. This study serves as a proof of concept for the use of an AR head mounted device in a real-world sterile setting in orthopedic 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.…”

“…After preoperative imaging, Digital Imaging and Communications in Medicine (DICOM) formatted data are typically provided which can be read in an open source library, such as 3D Slicer ( , accessed on 23 March 2022) [ 46 , 65 , 74 , 87 ], or proprietary software, such as Mimics ( , accessed on 23 March 2022) [ 47 , 61 , 88 ] or Brainlab ( , accessed on 23 March 2022) [ 67 , 84 ]. Surface rendered models provide enormous utility due to their ease of creation, lightweight model representation, and additional modifiable visualization properties, such as color, transparency, wireframe representations, and heatmaps [ 89 ].…”

“…The most commonly reported OST-HMD-led tracking solution was surface tracking, involving the use of the RGB camera capabilities of the headset, and square marker fiducials, such as those used in the Vuforia [ 64 , 69 , 74 , 96 ] (PTC, Boston, MA, USA) or ArUco [ 31 , 46 , 77 , 91 ] libraries. There were several papers which reported the use of custom markers for surface-based tracking, though the performance did not significantly differ from ArUco or Vuforia tracking solutions [ 82 , 97 ].…”

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

“…Another technology that is gaining popularity in surgical procedures, including orthopedic surgery, is augmented reality (AR) [ 15 , 16 ]. It displays computer-generated elements which augment and enrich the visualization of the physical world.…”

Comparison of the Observation Errors of Augmented and Spatial Reality Systems

“…Technological advances have made it possible to capture the unseen [3][4][5]. These advances in technology allow visual aids through visualization to traditional blind tasks that rely on sensory approaches derived from clinical experience [6,7]. In the dental field, its use for surgical guidance, navigation, and clinical education is being considered [2,8,9].…”