Supporting mandibular resection with intraoperative navigation utilizing augmented reality technology – A proof of concept study

Pietruski, Piotr; Majak, Marcin; Świątek‐Najwer, Ewelina; Żuk, Magdalena; Popek, Michał; Mazurek, Maciej; Świecka, Marta; Jaworowski, Janusz

doi:10.1016/j.jcms.2019.03.004

Cited by 41 publications

(45 citation statements)

References 32 publications

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“…First, a per-operative visual inspection after guided placement confirmed that no gap remained between the flange and the mandibular bone at the osteotomy sites. Second, postoperative analysis of CBCT scans showed a high accuracy of placement, with 3D deviations comparable to our prior studies and of others, using surgical guides (Kraeima, Dorgelo, et al, 2018;Kraeima, Merema, et al, 2018;Pietruski et al, 2019;Schepers et al, 2016;van Baar, Forouzanfar, Liberton, Winters, & Leusink, 2018;Vosselman et al, 2018). Additionally, careful inspection of the postoperative CBCT scans confirmed contact between the osteotomy sites and bookshelf-like flanges of the RPs as well as the remainder bone-plate interface, which indicates proper positioning with a small potential shift in the osteotomy plane.…”

Section: Discussionsupporting

confidence: 84%

Novel finite element‐based plate design for bridging mandibular defects: Reducing mechanical failure

et al. 2020

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Introduction When the application of a free vascularised flap is not possible, a segmental mandibular defect is often reconstructed using a conventional reconstruction plate. Mechanical failure of such reconstructions is mostly caused by plate fracture and screw pull‐out. This study aims to develop a reliable, mechanically superior, yet slender patient‐specific reconstruction plate that reduces failure due to these causes. Patients and Methods Eight patients were included in the study. Indications were as follows: fractured reconstruction plate (2), loosened screws (1) and primary reconstruction of a mandibular continuity defect (5). Failed conventional reconstructions were studied using finite element analysis (FEA). A 3D virtual surgical plan (3D‐VSP) with a novel patient‐specific (PS) titanium plate was developed for each patient. Postoperative CBCT scanning was performed to validate reconstruction accuracy. Results All PS plates were placed accurately according to the 3D‐VSP. Mean 3D screw entry point deviation was 1.54 mm ( SD : 0.85, R : 0.10–3.19), and mean screw angular deviation was 5.76° ( SD : 3.27, R : 1.26–16.62). FEA indicated decreased stress and screw pull‐out inducing forces. No mechanical failures appeared (mean follow‐up: 16 months, R : 7–29). Conclusion Reconstructing mandibular continuity defects with bookshelf‐reconstruction plates with FEA underpinning the design seems to reduce the risk of screw pull‐out and plate fractures.

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Section: Discussionsupporting

confidence: 84%

Novel finite element‐based plate design for bridging mandibular defects: Reducing mechanical failure

et al. 2020

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“…Pietruski et al developed an AR navigation system used to perform osteotomies on a phantom mandible using a virtually projected saw. 27 Their 'simple AR' method is comparable to the method in this study; namely, based on the navigation data rather than exact alignment and visual guidance of the AR content. Although their accuracy includes the registration error of the navigation system, using 2 control points they obtained an mean accuracy of 1.77 mm ( §0.82mm) and 1.88 mm ( §1.05mm).…”

Section: Discussionmentioning

confidence: 88%

Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom

Glas

Kraeima

Ooijen

et al. 2021

Journal of Oral and Maxillofacial Surgery

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Background: Oral and maxillofacial surgery currently relies on virtual surgery planning based on image data (CT, MRI). Three-dimensional (3D) visualizations are typically used to plan and predict the outcome of complex surgical procedures. To translate the virtual surgical plan to the operating room, it is either converted into physical 3D-printed guides or directly translated using real-time navigation systems.Purpose: This study aims to improve the translation of the virtual surgery plan to a surgical procedure, such as oncologic or trauma surgery, in terms of accuracy and speed. Here we report an augmented reality visualization technique for image-guided surgery. It describes how surgeons can visualize and interact with the virtual surgery plan and navigation data while in the operating room. The user friendliness and usability is objectified by a formal user study that compared our augmented reality assisted technique to the gold standard setup of a perioperative navigation system (Brainlab). Moreover, accuracy of typical navigation tasks as reaching landmarks and following trajectories is compared.Results: Overall completion time of navigation tasks was 1.71 times faster using augmented reality (P = .034). Accuracy improved significantly using augmented reality (P < .001), for reaching physical landmarks a less strong correlation was found (P = .087). Although the participants were relatively unfamiliar with VR/AR (rated 2.25/5) and gesture-based interaction (rated 2/5), they reported that navigation tasks become easier to perform using augmented reality (difficulty Brainlab rated 3.25/5, Holo-Lens 2.4/5). Conclusion:The proposed workflow can be used in a wide range of image-guided surgery procedures as an addition to existing verified image guidance systems. Results of this user study imply that our technique enables typical navigation tasks to be performed faster and more accurately compared to the

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“…Recent approaches accurately projected and executed single osteotomies in the midface, but only focused on 2D pixel errors between executed and planned osteotomies. 30 Several authors 17,18,20,25,26 have navigated the saw against the osteotomy target while simultaneously implementing real-time feedback. This technique improved osteotomy plane angulation to the disadvantage of invasive marker fixation.…”

Section: Discussionmentioning

confidence: 99%

“…12 Challenging limitations, such as invasive marker fixation or complex technical issues concerning line-of-sight difficulties and image-shifting, prevent the broad clinical implementation of ARguided navigation. [13][14][15] In the field of cranio-maxillofacial surgery, studies have implemented AR for frontal sinus approaches, 16 free fibula flap harvesting 17,18 and osteotomies of the mandible 19,20 and the midface. 21 However, using AR to guide the harvesting of iliac crest grafts has not been investigated.…”

mentioning

confidence: 99%

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

Winnand

Ayoub

Redick

et al. 2021

Robotics Computer Surgery

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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.

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Supporting mandibular resection with intraoperative navigation utilizing augmented reality technology – A proof of concept study

Cited by 41 publications

References 32 publications

Novel finite element‐based plate design for bridging mandibular defects: Reducing mechanical failure

Novel finite element‐based plate design for bridging mandibular defects: Reducing mechanical failure

Augmented Reality Visualization for Image-Guided Surgery: A Validation Study Using a Three-Dimensional Printed Phantom

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

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