Surgical Process Modeling for Open Spinal Surgeries

Abstract

Modern operating rooms are becoming increasingly advanced thanks to the emerging medical technologies and cutting-edge surgical techniques. Current surgeries are transitioning into complex processes that involve information and actions from multiple resources. When designing context-aware medical technologies for a given intervention, it is of utmost importance to have a deep understanding of the underlying surgical process. This is essential to develop technologies that can correctly address the clinical needs and can adapt to the existing workflow. Surgical Process Modeling (SPM) is a relatively recent discipline that focuses on achieving a profound understanding of the surgical workflow and providing a model that explains the elements of a given surgery as well as their sequence and hierarchy, both in quantitative and qualitative manner. To date, a significant body of work has been dedicated to the development of comprehensive SPMs for minimally invasive baroscopic and endoscopic surgeries, while such models are missing for open spinal surgeries. In this paper, we provide SPMs common open spinal interventions in orthopedics. Direct video observations of surgeries conducted in our institution were used to derive temporal and transitional information about the surgical activities. This information was later used to develop detailed SPMs that modeled different primary surgical steps and highlighted the frequency of transitions between the surgical activities made within each step. Given the recent emersion of advanced techniques that are tailored to open spinal surgeries (e.g., artificial intelligence methods for intraoperative guidance and navigation), we believe that the SPMs provided in this study can serve as the basis for further advancement of next-generation algorithms dedicated to open spinal interventions that require a profound understanding of the surgical workflow (e.g., automatic surgical activity recognition and surgical skill evaluation). Furthermore, the models provided in this study can potentially benefit the clinical community through standardization of the surgery, which is essential for surgical training.

Translation of Medical AR Research into Clinical Practice

“…In the following sections, we showcase the translational process of medical AR research from an early-stage proof-of-concept towards clinical studies, explained through an exemplary use case from spinal fusion surgery called HoloNavigation [ 8 , 9 , 10 , 11 , 12 , 13 ]. The HoloNavigation project was conducted within a large research initiative called SURGENT ( , accessed on 7 September 2022), an acronym for Surgeon Enhancing Technologies.…”

“…Clinical requirement engineering defines a standardized and formal representation of a treatment through process models. In the case of HoloNavigation , a process model is created for the use case of spinal fusion surgery [ 8 ] by hierarchically decomposing the operation into phases, steps, sub-steps, and actions [ 14 , 15 ].…”