Introduction
Minimally invasive surgery refers to surgery that requires a minimum incision to the surgical site, which gives quicker healing and no scars. Assisted reality is the technology that guides doctors during minimally invasive surgery. Advanced technologies and techniques have revolutionized minimally invasive surgery (MIS). The invention of AR has changed the way surgeons practice surgery. Advanced technologies such as advanced instrumentation, better visualization, robotics, and computer systems bring new possibilities to the operating room (OT). These technologies provide advantages to the patient as well as doctors. The doctors should be skilled to adapt to newer technologies. The article focuses on the advantages and the application of AR in minimally invasive surgery.
What Is Augmented Reality Guidance In Minimally Invasive Surgery?
Augmented reality (AR) guidance is a technology that can enhance the visualization and navigation of surgeons during minimally invasive surgery (MIS). AR can overlay virtual images or information on the real surgical scene, such as the patient’s anatomy, the surgical tools, or the planned trajectory. AR can help surgeons perform MIS more accurately, safely, and efficiently by reducing the reliance on external monitors, improving ergonomics, and facilitating intraoperative planning and decision-making.
AR guidance can be applied to different types of MIS, such as spine surgery, liver surgery, cardiac surgery, and neurosurgery. Some examples of AR guidance systems are:
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The AR-MIS system combines AR, artificial intelligence, and optical tracking to provide AR radiograph superimposition, real-time puncture needle tracking, and intraoperative navigation for minimally invasive spine surgery.
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The Resection Map is a navigation system that uses AR to display the resection planes and margins for liver surgery.
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The Endoclamp positioning system uses AR to visualize and control catheters for minimally invasive cardiac procedures.
AR guidance is a promising and rapidly evolving field with many potential benefits and challenges for MIS.
What Is the Augmentation Reality System for Minimally Invasive Surgery?
AR and Virtual Reality (VR) tools can assist not just during an intervention but also in its preparation and subsequent procedures. Nonetheless, AR is a multifaceted technology. Studies on AR-assisted treatments usually focus on specific phases or elements of a surgical process. Therefore, integrating AR into clinical practices demands a meticulously designed software framework. This framework should ensure consistent services in areas like image processing, visualization, and tracking, catering to diverse situations and needs. The task at hand is to offer efficient components that are adaptable enough for use across various applications. By breaking down components, it becomes easier to test them individually, facilitating unit tests. Additionally, this approach simplifies the process of approving software components for clinical assessment.
The AR system generally has three components:
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Consistent Data Models - The requirement of data based on scanned images is important for planned surgery. The structure and pathological defects can be concluded from the data of scanned images. Physicians demand predictable results so that they can plan further surgery that permits the medical workflow and saves time. The data also allows arbitrary changes if needed.
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Real-time Data Acquisition - Unlike methods like CT (computed tomography) or MRI (Magnetic resonance imaging), which are typically not obtained in real-time, AR applications necessitate managing continuous input data like tracking, ultrasound, or video data. Managing this data demands real-time algorithms and meticulous synchronization, especially when dealing with data acquired simultaneously from diverse sources.
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Visualization - AR has an advanced system of visualization as compared to conventional systems like MRI or CT scans. AR gives the best visualization of the defect. The techniques of AR are best for viewing defects and their analysis. It displays all kinds of data in real-time. It has applications in many areas, such as surgical sites, or coordination of the hand to the eye during surgery.
What Are the Applications Of the AR In Medical Areas?
A primary advantage of AR in medical contexts lies in its capacity to address challenges associated with hand-eye coordination. For instance, AR displays can accurately depict where actions need to occur by integrating virtual objects into real-world settings. Another approach is to incorporate this guidance directly onto the conventional 2D screen.
The following are the medical applications of the AR:
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Neurosurgery and Orthopedics - AR have already made a place in minimally invasive surgery. Nowadays, these advanced systems are used in brain or nerve surgery and bone-related surgery (orthopedic intervention). AR technologies are increasing in the safety, aesthetics, and functional uses of surgical procedures like jaw-related surgeries, joint surgeries, and dental procedures. These advanced technologies are used to make virtual counterparts of the real structure, which enhances the experiments and their results. These applications are also used to create 3D models.
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Soft Tissue Surgery - Soft-tissue surgery presents unique technical hurdles. Current studies emphasize the challenges of handling intra-operative deformations, organ shifts, and topological alterations. Given these complexities, only a few research models can provide a real-time navigation setting within a stationary anatomy, pinpointing tool locations on preoperative or intraoperative 3D scans. For virtual models to mirror real-world organs, they must adjust to actual deformations. Thus, apart from the primary components of a medical AR system, the data model creating the AR visuals needs updates to align with organ deformations. At present, many soft-tissue navigation systems primarily target liver surgeries due to their clinical significance, with liver cancer ranking among the leading causes of mortality. As mentioned earlier, improving outcomes hinges on precise control over resection margins and critical areas like major vessels during procedures. Leveraging AR technology has proven effective, especially in guiding needles for tumor ablation, even when adopting a laparoscopic approach.
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Catheterised Interventional Procedures - Interventional procedures involve minimally invasive techniques where a medical professional, often a radiologist, conducts a procedure using a small catheter inserted into the blood vessels. In many instances, the procedure is observed using angiographic imaging, enabling visualization of both the catheter and anatomical structures. This typically relies on methods such as X-ray fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound (US) imaging, often with the use of contrast agents. Nevertheless, these traditional imaging methods have drawbacks, including their bulkiness, reliance on ionizing radiation, or limited resolution.
Conclusion
Surgery is progressing toward a safer, minimally invasive method, propelled by various technological advancements. Surgeons are increasingly integrating augmented reality (AR) systems to enhance their orientation and precision, making AR technology a key catalyst in modern surgical advancements. Research in this domain is multifaceted. A primary focus is on minimizing the technological complexities in the operating room, exploring solutions such as tool tracking through video analysis. Additionally, efforts are underway to establish the scientific and technological foundations for offering tactile feedback in robotic systems. Addressing organ deformation and displacement during soft tissue surgeries remains among the most challenging tasks. The application of AR in surgery enhances results, saves time, and provides minimal invasion to the surgical site. Minimally invasive surgery gives minimal scars, and it has a quicker healing mechanism. AR has many more advantages, such as providing better visualization and providing accurate analysis of scanned images.
