Augmented reality with HoloLens in parotid surgery: how to assess and to improve accuracy

Scherl, Claudia; Stratemeier, Johanna; Karle, Celine; Rotter, Nicole; Hesser, Jürgen; Huber, Lena; Dias, Andre; Hoffmann, Oliver; Riffel, Philipp; Schoenberg, Stefan O.; Schell, Angela; Lammert, Anne; Affolter, Annette; Männle, David

doi:10.1007/s00405-020-06351-7

Cited by 27 publications

(27 citation statements)

References 19 publications

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“…Despite these drawbacks, OST-based HMDs are mostly considered for surgical applications [11,12,14,19,29] for their intrinsic comfort of the full-scale resolution fruition of the real world and for the fact that they allow the safe completion of every task even if the display fails, since the direct view of reality is not compromised [22,30]. In VST, a technical issue causing the failure of the displays will cause the critical need to remove the HMD to allow the continuation of the task.…”

Section: Theorymentioning

confidence: 99%

“…Many authors report proof of concept experience in the surgical room with commercially available devices [8][9][10][11][12][13][14], underlining the enthusiasm of the surgical world in exploring the potentialities of AR HMDs but also appraising the limitation of using a device not engineered for the surgical tasks: (1) perceptual issues related to the rendering appropriate focus cues [15][16][17], (2) the absence of a framework specifically dedicated to the medical applications [18], (3) the need for a design that takes into consideration the surgeon posture to avoid neck overload [19,20] and the need of maintaining the sterility of his hands, and (4) the need for a millimetric virtual to real registration accuracy in many interventions.…”

Section: Introductionmentioning

confidence: 99%

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Architecture of a Hybrid Video/Optical See-through Head-Mounted Display-Based Augmented Reality Surgical Navigation Platform

et al. 2022

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In the context of image-guided surgery, augmented reality (AR) represents a ground-breaking enticing improvement, mostly when paired with wearability in the case of open surgery. Commercially available AR head-mounted displays (HMDs), designed for general purposes, are increasingly used outside their indications to develop surgical guidance applications with the ambition to demonstrate the potential of AR in surgery. The applications proposed in the literature underline the hunger for AR-guidance in the surgical room together with the limitations that hinder commercial HMDs from being the answer to such a need. The medical domain demands specifically developed devices that address, together with ergonomics, the achievement of surgical accuracy objectives and compliance with medical device regulations. In the framework of an EU Horizon2020 project, a hybrid video and optical see-through augmented reality headset paired with a software architecture, both specifically designed to be seamlessly integrated into the surgical workflow, has been developed. In this paper, the overall architecture of the system is described. The developed AR HMD surgical navigation platform was positively tested on seven patients to aid the surgeon while performing Le Fort 1 osteotomy in cranio-maxillofacial surgery, demonstrating the value of the hybrid approach and the safety and usability of the navigation platform.

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Section: Theorymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Architecture of a Hybrid Video/Optical See-through Head-Mounted Display-Based Augmented Reality Surgical Navigation Platform

et al. 2022

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“…Manual registration, which showed a mean error of alignment of 12.4 mm, would be another option. After appropriate training or assistance by fiducial markers, the error was reduced to 10 mm [ 11 , 33 ]. Consequently, image-based registration with Vuforia, which is much more accurate, is still the method of choice for most applications [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study

Puladi¹,

Ooms²,

Bellgardt³

et al. 2022

JMIR Serious Games

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Background Although nearly one-third of the world’s disease burden requires surgical care, only a small proportion of digital health applications are directly used in the surgical field. In the coming decades, the application of augmented reality (AR) with a new generation of optical-see-through head-mounted displays (OST-HMDs) like the HoloLens (Microsoft Corp) has the potential to bring digital health into the surgical field. However, for the application to be performed on a living person, proof of performance must first be provided due to regulatory requirements. In this regard, cadaver studies could provide initial evidence. Objective The goal of the research was to develop an open-source system for AR-based surgery on human cadavers using freely available technologies. Methods We tested our system using an easy-to-understand scenario in which fractured zygomatic arches of the face had to be repositioned with visual and auditory feedback to the investigators using a HoloLens. Results were verified with postoperative imaging and assessed in a blinded fashion by 2 investigators. The developed system and scenario were qualitatively evaluated by consensus interview and individual questionnaires. Results The development and implementation of our system was feasible and could be realized in the course of a cadaver study. The AR system was found helpful by the investigators for spatial perception in addition to the combination of visual as well as auditory feedback. The surgical end point could be determined metrically as well as by assessment. Conclusions The development and application of an AR-based surgical system using freely available technologies to perform OST-HMD–guided surgical procedures in cadavers is feasible. Cadaver studies are suitable for OST-HMD–guided interventions to measure a surgical end point and provide an initial data foundation for future clinical trials. The availability of free systems for researchers could be helpful for a possible translation process from digital health to AR-based surgery using OST-HMDs in the operating theater via cadaver studies.

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“…However, the accuracy is user dependent and may not be sufficient for some surgical tasks. Pratt et al (2018) and Scherl et al (2020) use manual alignment to the anatomy, whereas Creighton et al ( 2020) register to fiducial markers for guidance of targets in the skull base.…”

Section: Markerless Trackingmentioning

confidence: 99%

Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review

Birlo

Edwards

Clarkson

et al. 2022

Medical Image Analysis

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Augmented reality with HoloLens in parotid surgery: how to assess and to improve accuracy

Cited by 27 publications

References 19 publications

Architecture of a Hybrid Video/Optical See-through Head-Mounted Display-Based Augmented Reality Surgical Navigation Platform

Architecture of a Hybrid Video/Optical See-through Head-Mounted Display-Based Augmented Reality Surgical Navigation Platform

Augmented Reality-Based Surgery on the Human Cadaver Using a New Generation of Optical Head-Mounted Displays: Development and Feasibility Study

Utility of optical see-through head mounted displays in augmented reality-assisted surgery: A systematic review

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