不同现实可视化系统在麻醉领域中的应用

随着全息影像技术的高速发展,其提供的高级可视化技术和交互式医疗体验使得不同的现实可视化系统在医学上的应用日益广泛。文章综述了不同现实可视化系统,如虚拟现实（virtual reality, VR）系统、增强现实（augmented reality, AR）系统及混合现实（mixed reality, MR）系统的定义及...     

Extended,virtual and augmented reality in thoracic surgery: a systematic review

 Open in a separate windowOBJECTIVESExtended reality (XR), encompassing both virtual reality (VR) and augmented reality, allows the user to interact with a computer-generated environment based on reality. In essence, the immersive nature of VR and augmented reality technology has been warmly welcomed in all aspects of medicine, gradually becoming increasingly feasible to incorporate into everyday practice. In recent years, XR has become increasingly adopted in thoracic surgery, although the extent of its applications is unclear. Here, we aim to review the current applications of XR in thoracic surgery.METHODSA systematic database search was conducted of original articles that explored the use of VR and/or augmented reality in thoracic surgery in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to December 2020.RESULTSOur search yielded 1494 citations, of which 21 studies published from 2007 to 2019 were included in this review. Three main areas were identified: (i) the application of XR in thoracic surgery training; (ii) preoperative planning of thoracic procedures; and (iii) intraoperative assistance. Overall, XR could produce progression along the learning curve, enabling trainees to reach acceptable standards before performing in the operating theatre. Preoperatively, through the generation of 3D-renderings of the thoracic cavity and lung anatomy, VR increases procedural accuracy and surgical confidence through familiarization of the patient’s anatomy. XR-assisted surgery may have therapeutic use particularly for complex cases, where conventional methods would yield inadequate outcomes due to inferior accuracy.CONCLUSIONXR represents a salient step towards improving thoracic surgical training, as well as enhancing preoperative planning and intraoperative guidance.     

混合现实技术在肝胆外科领域中的应用

混合现实是将虚拟的数字世界与现实世界融合在一起的全新三维呈现技术, 在肝胆外科领域已经得到了初步应用。相比于虚拟现实、增强现实及三维可视化技术, 混合现实技术在手术前评估及制定手术方案、术中实时精准导航及三维虚拟教学中具有独特优势, 是实施精准肝胆外科手术的新一代辅助工具。本文对混合现实技术在肝胆外科领域中的应用及研究进展进行阐述, 探讨其应用潜力和目前的局限性。     

The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomised controlled trial

In children, the pain and anxiety associated with acute burn dressing changes can be severe, with drug treatment alone frequently proving to be inadequate. Virtual reality (VR) systems have been successfully trialled in limited numbers of adult and paediatric burn patients. Augmented reality (AR) differs from VR in that it overlays virtual images onto the physical world, instead of creating a complete virtual world. This prospective randomised controlled trial investigated the use of AR as an adjunct to analgesia and sedation in children with acute burns. Forty-two children (30 male and 12 female), with an age range of 3-14 years (median age 9 years) and a total burn surface area ranging from 1 to 16% were randomised into a treatment (AR) arm and a control (basic cognitive therapy) arm after administration of analgesia and/or sedation. Pain scores, pulse rates (PR), respiratory rates (RR) and oxygen saturations (SaO(2)) were recorded pre-procedurally, at 10min intervals and post-procedurally. Parents were also asked to grade their child's overall pain score for the dressing change. Mean pain scores were significantly lower (p=0.0060) in the AR group compared to the control group, as were parental pain assessment scores (p=0.015). Respiratory and pulse rates showed significant changes over time within groups, however, these were not significantly different between the two study groups. Oxygen saturation did not differ significantly over time or between the two study groups. This trial shows that augmented reality is a useful adjunct to pharmacological analgesia.     

Augmented Reality- vs Accelerometer-Based Portable Navigation System to Improve the Accuracy of Acetabular Cup Placement During Total Hip Arthroplasty in the Lateral Decubitus Position

BackgroundThere have been no studies regarding the effectiveness of augmented reality (AR)-based portable navigation systems compared with accelerometer-based portable navigation systems in total hip arthroplasty (THA).MethodsWe retrospectively compared THAs performed using an AR-based portable navigation system (n = 45) and those performed using an accelerometer-based portable navigation system (n = 42). All THAs were performed with the patient in the lateral decubitus position. The primary outcome was the absolute difference between cup placement angles displayed on the navigation screen and those measured on postoperative X-ray.ResultsThe mean absolute differences were significantly smaller in the AR-based portable navigation system group than the accelerometer-based portable navigation system group in radiographic inclination (2.5° ± 1.7° vs 4.6° ± 3.1°; 95% confidence interval 1.1°-3.2°, P < .0001). Similarly, the mean absolute differences were significantly better in the AR-based portable navigation system group in radiographic anteversion (2.1° ± 1.8° vs 6.4° ± 4.2°; 95% confidence interval 3.0°-5.7°, P < .0001). Neither hip dislocation, surgical site infection, nor other complications associated with use of the navigation system occurred in either group.ConclusionThe AR-based portable navigation system may provide more precise acetabular cup placement compared with the accelerometer-based portable navigation system in THA.     

Physical reality simulation for training of laparoscopists in the 21st century. A multispecialty, multi-institutional study.

BACKGROUND: Simulation is the most effective and safe way to train laparoscopic surgeons in an era of limited work hours, lack of funding, and increasing malpractice costs. However, the costs associated with the use of virtual reality simulators are significant, and although very technically sophisticated they still lack tactile feedback. We are proposing a physical reality simulator, the LTS 2000, as a reliable and effective alternative to virtual reality. This study was carried out to establish how reliably the simulator was able to differentiate between different levels of laparoscopic experience and to analyze the detection of skills improvement after simulation and clinical training. METHODS: This study was carried out, between July 2002 and August 2003, in the departments of Surgery and Obstetrics and Gynecology at 2 separate institutions. We enrolled 40 individuals in the study who had experience ranging from postgraduate year-1 to full-time faculty level. Five postgraduate year-3 residents were subsequently retested after rotating on clinical services, performing advanced laparoscopic procedures to assess whether the simulator was sensitive enough to detect improvements in laparoscopic skills at the intermediate level. Six tasks were included in the test, and they were scored for speed and precision with the McGill system. Two scores were obtained: a coordination score and a suturing score combined in a total score. Other variables analyzed were handedness, specialty, number of laparoscopic procedures performed, and hours spent on the simulator. RESULTS: Forty-five tests were performed. The number of subjects in each group based on level of experience was equally distributed. No difference occurred in scores between institutions, specialty, and right- or left-handed surgeons. A significant increase occurred in the coordination score and suturing score combined in the total score with increasing experience (P < 0.05) at each level. Furthermore, the simulator was sensitive enough to detect a significant difference in all 3 scores between subjects who had practiced with the simulator before being tested (P < 0.05). The scores of the 5 postgraduate year-3 participants doubled when tested, without reaching statistical significance due to the small sample size. CONCLUSIONS: Our study shows that the LTS 2000 reliably and reproducibly detects different levels of laparoscopic expertise and progression of the learning curve. LTS 2000 as a model of physical reality simulation should be considered a reliable alternative to virtual reality simulation.     

增强/混合现实技术在头颈外科的应用及展望

利用增强/混合现实技术以辅助疾病的诊疗和医学教育,是目前国际上数字医学关注的热点。本文对增强/混合现实技术在头颈部外科的应用现状与发展前景进行综述,为进一步的研究提供参考。     

应用增强现实与混合现实导航预防腹腔镜肝切除术中出血价值研究

目的 研究应用增强现实与混合现实导航技术预防腹腔镜肝切除术中出血的价值。方法 回顾性分析2018年1月至2021年7月南方医科大学珠江医院肝胆一科收治171例行腹腔镜肝切除术治疗肝脏恶性肿瘤病人临床资料,分为增强现实与混合现实腹腔镜肝切除手术导航组（A组）和常规腹腔镜肝切除组（B组）。其中A组108例,术中采用自主研发的3D腹腔镜增强现实与混合现实手术导航系统将术前三维模型、3D腹腔镜场景进行多模图像实时融合与交互,在导航技术引导下完成腹腔镜肝切除术。B组63例,未采用手术导航技术,采用常规腹腔镜肝切除。分别采用t 检验、Wilcoxon秩和检验、χ2检验对临床数据进行统计学分析。结果 两组病人的术前资料差异均无统计学意义。术中指标中,A组术中出血量少于B组［（263.9±147.0） mL vs.（405.6±286.5） mL,P＜0.01）］,差异有统计学意义;A组术中输血率低于B组（9.3% vs. 31.7%,P＜0.01）,差异有统计学意义;两组病人均无严重并发症发生及围手术期死亡。结论 在腹腔镜肝切除中应用增强现实与混合现实导航技术出血更少,有更好的手术安全性,对术中预防出血具有重要的应用价值。     

A Pilot Study of Augmented Reality Technology Applied to the Acetabular Cup Placement During Total Hip Arthroplasty

Background

We developed an acetabular cup placement device, the AR-HIP system, using augmented reality (AR). The AR-HIP system allows the surgeon to view an acetabular cup image superimposed in the surgical field through a smartphone. The smartphone also shows the placement angle of the acetabular cup. This preliminary study was performed to assess the accuracy of the AR-HIP system for acetabular cup placement during total hip arthroplasty (THA).

Real-time 3D image reconstruction guidance in liver resection surgery

Background

Minimally invasive surgery represents one of the main evolutions of surgical techniques. However, minimally invasive surgery adds difficulty that can be reduced through computer technology.

Methods

From a patient’s medical image [US, computed tomography (CT) or MRI], we have developed an Augmented Reality (AR) system that increases the surgeon’s intraoperative vision by providing a virtual transparency of the patient. AR is based on two major processes: 3D modeling and visualization of anatomical or pathological structures appearing in the medical image, and the registration of this visualization onto the real patient. We have thus developed a new online service, named Visible Patient, providing efficient 3D modeling of patients. We have then developed several 3D visualization and surgical planning software tools to combine direct volume rendering and surface rendering. Finally, we have developed two registration techniques, one interactive and one automatic providing intraoperative augmented reality view.

Results

From January 2009 to June 2013, 769 clinical cases have been modeled by the Visible Patient service. Moreover, three clinical validations have been realized demonstrating the accuracy of 3D models and their great benefit, potentially increasing surgical eligibility in liver surgery (20% of cases). From these 3D models, more than 50 interactive AR-assisted surgical procedures have been realized illustrating the potential clinical benefit of such assistance to gain safety, but also current limits that automatic augmented reality will overcome.

Conclusions

Virtual patient modeling should be mandatory for certain interventions that have now to be defined, such as liver surgery. Augmented reality is clearly the next step of the new surgical instrumentation but remains currently limited due to the complexity of organ deformations during surgery. Intraoperative medical imaging used in new generation of automated augmented reality should solve this issue thanks to the development of Hybrid OR.     

Real world usability analysis of two augmented reality headsets in visceral surgery

Recent developments in the field of augmented reality (AR) have enabled new use cases in surgery. Initial set‐up of an appropriate infrastructure for maintaining an AR surgical workflow requires investment in appropriate hardware. We compared the usability of the Microsoft HoloLens and Meta 2 head mounted displays (HMDs). Fifteen medicine students tested each device and were questioned with a variant of the System Usability Scale (SUS). Two surgeons independently tested the devices in an intraoperative setting. In our adapted SUS, ergonomics, ease of use, and visual clarity of the display did not differ significantly between HMD groups. The field of view (FOV) was smaller in the Microsoft HoloLens than the Meta 2 and significantly more study subjects (80% vs. 13.3%; P < 0.001) felt limited through the FOV. Intraoperatively, decreased mobility due to the necessity of an AC adapter and additional computing device for the Meta 2 proved to be limiting. Object stability was rated superior in the Microsoft HoloLens than the Meta 2 by our surgeons and lead to increased use. In summary, after examination of the Meta 2 and the Microsoft HoloLens, we found key advantages in the Microsoft HoloLens which provided palpable benefits in a surgical setting.     

Technology-enhanced learning for surgeons

Modern surgical education is a rapidly changing field with the development of new and more accessible technology creating the opportunity to enhance a learner's experience. The appropriate use of technology within a structured learning programme that has educational principles embedded can result in safe and effective development for learners. This article aims to highlight some of the available and more innovative technology that can be utilized to develop a learner's knowledge, technical and non-technical skills and attitudes as they progress in surgical training.     

Role of artificial intelligence in hepatobiliary and pancreatic surgery

Over the past decade, enhanced preoperative imaging and visualization, improved delineation of the complex anatomical structures of the liver and pancreas, and intra-operative technological advances have helped deliver the liver and pancreatic surgery with increased safety and better postoperative outcomes. Artificial intelligence (AI) has a major role to play in 3D visualization, virtual simulation, augmented reality that helps in the training of surgeons and the future delivery of conventional, laparoscopic, and robotic hepatobiliary and pancreatic (HPB) surgery; artificial neural networks and machine learning has the potential to revolutionize individualized patient care during the preoperative imaging, and postoperative surveillance. In this paper, we reviewed the existing evidence and outlined the potential for applying AI in the perioperative care of patients undergoing HPB surgery.