Navigation of iliac crest graft harvest using markerless augmented reality and cutting guide technology: A pilot study

Abstract

Background: Defects of the facial skeleton often require complex reconstruction with vascularized grafts. This trial elucidated the usability, visual perception and accuracy of a markerless augmented reality (AR)-guided navigation for harvesting iliac crest transplants.Methods: Random CT scans were used to virtually plan two common transplant configurations on 10 iliac crest models, each printed four times. The transplants were harvested using projected AR and cutting guides. The duration and accuracies of the angulation, distance and volume between the planned and executed osteotomies were measured.Results: AR was characterized by the efficient use of time and accurate rendition of preoperatively planned geometries. However, vertical osteotomies and complex anatomical settings displayed significant inferiority of AR guidance compared to cutting guides. Conclusions:This study demonstrated the usability of a markerless AR setup for harvesting iliac crest transplants. The visual perception and accuracy of the ARguided osteotomies constituted remaining weaknesses against cutting guide technology.

Augmented and Virtual Reality Applications in Facial Plastic Surgery: A Scoping Review

“…Manzie et al recently developed a VR environment for planning a fibula‐free flap for mandible reconstruction and trialed it with 13 participants at a medical conference who all reported usefulness of the tool 59 . Winnand et al developed an AR‐assisted robotic system and tested it for iliac crest graft harvest on a 3D‐printed model 57 . In 2017, Jiang et al evaluated the feasibility of their AR navigation system for perforator flap transplantation on a dog and found accurate display of a vascular map on the surgical site 53 .…”

“…The clinical areas most represented in this category were CMF with 10 studies, 27,[43][44][45][46][47][48][49][50][51] followed by free flaps with studies. 32,[52][53][54][55][56][57][58][59] Other clinical areas among the feasibility studies were face transplant (n = 1), 60 facial palsy rehabilitation (n = 1), 61 head and neck surgery (n = 1), 62 dermal filler injections (n = 3), 42,63,64 locoregional flaps (n = 2), 37,65 microtia reconstruction (n = 1), 66 plastic surgery (n = 1), 67 external frontal sinus approaches (n = 1), 68 and facial trauma (n = 2) (Table IV). 21,23,69 Most CMF studies (n = 7) described using XR for mandible contouring in particular.…”

“…59 Winnand et al developed an AR-assisted robotic system and tested it for iliac crest graft harvest on a 3D-printed model. 57 In 2017, Jiang et al evaluated the feasibility of their AR navigation system for perforator flap transplantation on a dog and found accurate display of a vascular map on the surgical site. 53 They subsequently trialed an updated system on a 3D-printed human thigh model and were able to successfully display the vascular anatomy with perforators in AR.…”

Mixed-reality and computer-aided design/computer-aided manufacturing technology for mandibular reconstruction: a case description

“…The future potential of AR-guided navigation seems promising due to the method’s lower costs, reduced logistical efforts, and intraoperative flexibility in comparison with CAD/CAM and cutting-guide technologies ( 16 ). However, a limitation of this method is that aligning the surgical field and the MR is performed manually, and the accuracy is expected to improve further by alignment using a registration marker.…”

Augmented reality for orthopedic and maxillofacial oncological surgery: a systematic review focusing on both clinical and technical aspects

“…In the field of maxillofacial oncology (Scolozzi and Bijlenga, 2017;Battaglia et al, 2019;Gsaxner et al, 2019;Pepe et al, 2019;Kim et al, 2020;García-Sevilla et al, 2021b;Gsaxner et al, 2021;Meng et al, 2021;Ochandiano et al, 2021;Sahovaler et al, 2021;Scherl et al, 2021;Sugahara et al, 2021;Tel et al, 2021;Ceccariglia Cercenelli et al, 2022;Chan H et al, 2022;Gao et al, 2022;Han et al, 2022;Modabber et al, 2022;Shi et al, 2022;Tang et al, 2022;Winnand et al, 2022;Yang et al, 2022;Necker et al, 2023;Prasad et al, 2023;Shaofeng et al, 2023;Zhao et al, 2023), in the majority of articles (n = 14) the proposed AR systems were tested on phantoms, and 8 on patients only. Five researcher groups carried out pre-clinical research on phantoms before using AR on patients.…”