扩展现实技术在显微外科及其教学中的应用价值

扩展现实（extended reality, XR）技术是虚拟现实（virtual reality, VR）、增强现实（augmented reality, AR）及混合现实（mixed reality, MR）技术的统称,已被广泛用于医学临床实践与教学等领域。笔者从当前显微外科教学面临的难点出发,介绍XR技术背景及代表性设备;总结XR技术应用于显微外科多个阶段（术前规划、术中导航及术后监测）的进展情况,并探讨显微外科教学培训中借助XR技术模拟解剖结构、手术操作演示和远程医学教育等方面的价值;进一步分析XR技术在实际应用中的优势和局限性,并对其未来的发展趋势进行展望。     

增强现实/混合现实技术在骨肿瘤外科手术规划及教学培训中的应用

增强现实(augmented reality,AR)与混合现实(mixed reality,MR)技术已逐步试用于多种骨科手术,如脊柱外科手术、关节外科手术、骨与软组织肿瘤切除、骨折复位内固定、关节镜手术及其他微创手术.初入21世纪,骨科学领域各项相关技术发展迅速,但由于骨与软组织结构和功能的复杂性,骨科疾患病种的多样...     

数字智能化诊疗技术在门静脉高压症中的应用

目前,三维可视化、3D打印、增强现实(aug-mented reality,AR)、虚拟现实(virtual reality,VR)、混合现实(mixed reality,MR)等数字智能化诊疗技术广泛应用于肝胆胰外科疾病的诊治,呈蓬勃发展之势[1].门静脉高压症的外科手术治疗有其独特的临床优势,是治疗中不可或缺的重要...     

VR/AR技术在手足显微外科手术操作教学中的应用

2004年卫生部修订教学大纲,将显微外科列入外科教学的范围内,要求医学院校的学生需了解显微外科的重要性及操作条件,为在各个学科专业开展医学工作打下基础.结合21世纪新兴的计算机仿真技术—虚拟现实技术(virtual reality,VR)/增强现实技术(augmented reality,AR),我院手足显微外科积极响...     

混合现实技术在肝胆胰领域中的应用进展

目的 了解混合现实（mixed reality,MR）技术在肝胆胰领域中的应用进展，以期为MR技术融入肝胆胰学科发展提供借鉴。方法 对近年来国内外关于MR技术在肝胆胰领域应用的相关文献进行综述。结果 MR技术已广泛应用于肝胆胰领域的术前诊断评估及手术方案的制定、医患沟通、术中导航精准手术、教学实践等诸多方面，具有缩短手术时间、降低手术难度和提高手术成功率的优势，在一定程度上推动了肝胆胰领域临床诊疗方式的创新。结论 MR相关技术的应用发展对于肝胆胰外科手术及教学有着重要意义。随着MR技术和现代医学的发展进步，MR技术必将在智能化实时导航肝胆胰手术系统方面充分发挥优势，推动肝胆胰领域的精准治疗进一步发展。     

增强现实、混合现实在泌尿外科导航手术中的应用

正目前的医学成像设备可以创建单个患者的疾病图像,将图像数据重建后的三维图像可以指导诊断和制定手术预案,在术中提供详细的导航指引。这种计算机辅助手术(computer assisted surgery,CAS)可以提高疾病诊断的准确性,同时提高手术的精准性(图1)。增强现实(augmented reality,AR)和混合现实(mixed reality,MR)是CAS的一种医学影像的应用,AR是虚拟信息叠加在现实事物上,相当于真实世界与数字化信息的结合,例     

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。     

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。     

增强现实与混合现实导航技术在三维腹腔镜缩小右半肝切除术中的应用

目的:探讨增强现实与混合现实导航技术在三维腹腔镜缩小右半肝切除中的应用效果。方法:回顾性分析2020年9月至2021年6月南方医科大学珠江医院肝胆一科收治的5例肝脏恶性肿瘤患者的病例资料,均为男性,年龄42~74岁。术前使用自主研发的腹部医学图像三维可视化系统进行术前评估,5例患者若行右半肝切除,则余肝体积不足,因而行...     

混合现实技术在骨科的最新应用进展

正混合现实技术是继虚拟现实技术(virtual reality,简称VR)、增强现实技术(augmented reality,简称AR)之后,出现的全新数字全息影像技术。该技术最核心的特性是打破了数字的虚拟世界与物理的真实世界的界限,从而将数字技术多年的量变积累突破到质变。     

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.     

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。