Augmented reality-assisted skull base surgery

Neuronavigation is widely considered as a valuable tool during skull base surgery. Advances in neuronavigation technology, with the integration of augmented reality, present advantages over traditional point-based neuronavigation. However, this development has not yet made its way into routine surgical practice, possibly due to a lack of acquaintance with these systems. In this report, we illustrate the usefulness and easy application of augmented reality-based neuronavigation through a case example of a patient with a clivus chordoma. We also demonstrate how augmented reality can help throughout all phases of a skull base procedure, from the verification of neuronavigation accuracy to intraoperative image-guidance.     

Feasibility and safety of augmented reality-assisted urological surgery using smartglass

Purpose

To assess the feasibility, safety and usefulness of augmented reality-assisted urological surgery using smartglass (SG).

Methods

Seven urological surgeons (3 board urologists and 4 urology residents) performed augmented reality-assisted urological surgery using SG for 10 different types of operations and a total of 31 urological operations. Feasibility was assessed using technical metadata (number of photographs taken/number of videos recorded/video time recorded) and structured interviews with the urologists on their use of SG. Safety was evaluated by recording complications and grading according to the Clavien–Dindo classification. Usefulness of SG for urological surgery was queried in structured interviews and in a survey.

Results

The implementation of SG use during urological surgery was feasible with no intrinsic (technical defect) or extrinsic (inability to control the SG function) obstacles being observed. SG use was safe as no grade 3–5 complications occurred for the series of 31 urological surgeries of different complexities. Technical applications of SG included taking photographs/recording videos for teaching and documentation, hands-free teleconsultation, reviewing patients’ medical records and images and searching the internet for health information. Overall usefulness of SG for urological surgery was rated as very high by 43 % and high by 29 % of surgeons.

Conclusions

Augmented reality-assisted urological surgery using SG is both feasible and safe and also provides several useful functions for urological surgeons. Further developments and investigations are required in the near future to harvest the great potential of this exciting technology for urological surgery.

     

Tele-surgery simulation with a patient organ model for robotic surgery training

Robotic systems are increasingly being incorporated into general laparoscopic and thoracoscopic surgery to perform procedures such as cholecystectomy and prostatectomy. Robotic assisted surgery allows the surgeon to conduct minimally invasive surgery with increased accuracy and with potential benefits for patients. However, current robotic systems have their limitations. These include the narrow operative field of view, which can make instrument manipulation difficult. Current robotic applications are also tailored to specific surgical procedures. For these reasons, there is an increasing demand on surgeons to master the skills of instrument manipulation and their surgical application within a controlled environment. This study describes the development of a surgical simulator for training and mastering procedures performed with the da Vinci surgical system. The development of a tele-surgery simulator and the construction of a training center are also described, which will enable surgeons to simulate surgery from or in remote places, to collaborate over long distances, and for off-site expert assistance.     

Image-guided robotic surgery

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.     

Trends in robotic surgery

Robotic surgery began as a technology-driven innovation but is now becoming a genuine method of improving healthcare effectiveness worldwide. This comprehensive review introduces the current trends, using examples of specific systems to distinguish the various types of robotic surgical devices, from remote handling machines to those performing delicate local interventions. We end by commenting on how to extend existing systems and provide an account of the rapid developments in minimally invasive robotic surgery.     

Computer-assisted robotic antireflux surgery

Antireflux surgery has evolved significantly since its inception 50 years ago. The current standard is laparoscopic fundoplication. The computer-assisted telemanipulator, a new device recently approved for use in laparoscopy, reduces some of the shortcomings of the laparoscopic approach. This review specifically discusses the role of this novel surgical tool in antireflux surgery.     

Learning curve using robotic surgery

The da Vinci (Intuitive Surgical, Inc., Sunnyvale, CA) surgical system is being used by an increasing number of surgeons across several surgical specialties. The robotic interface is different not only to open surgery, but also to laparoscopy because it involves remote surgical control, stereoscopic vision, and lack of haptic feedback. As the transition is made from traditional open to robotic surgery, factors such as learning of robotic skills, assessment of pro.ciency in robotics, and structured training for urologists in practice and residents assumes importance. Understanding how the robotic surgical technique is learned and how such learning can be best assessed will enable us to de.ne protocols for training and set standards for pro.ciency. Learning curve and surgical dexterity are two parameters that are used to compare surgical learning and training. This article presents the current gold standard for assessing skill training and compares surgical skill acquisition and pro.ciency using conventional laparoscopy and robotic interfaces.     

Laparoscopic principles of robotic surgery

The evolution of surgical therapy has been vertiginous, from the classical principles of open surgery to laparoscopy and currently to robotic surgery, in which the principles of robotic engineering have been successfully applied to the surgeon's daily work. The development of minimally invasive surgery, initially led by conventional laparoscopy, was a fertile field for the development of surgical techniques with the robot. The use of automatized systems for surgery is not as new as one could think, but the robots today participating in the main operative rooms worldwide are an example of the newest and most advanced available technology. Urology has become the leading surgical speciality in the application of technologies for diagnosis and treatment of its diseases, and robotic surgery is not an exception. We present our vision about the state of the art in automatized surgery, in the setting of its close relationship with conventional laparoscopic surgery, which originated it.