69 research outputs found
Bioengineering, augmented reality, and robotic surgery in vascular surgery: A literature review
Biomedical engineering integrates a variety of applied sciences with life sciences to improve human health and reduce the invasiveness of surgical procedures. Technological advances, achieved through biomedical engineering, have contributed to significant improvements in the field of vascular and endovascular surgery. This paper aims to review the most cutting-edge technologies of the last decade involving the use of augmented reality devices and robotic systems in vascular surgery, highlighting benefits and limitations. Accordingly, two distinct literature surveys were conducted through the PubMed database: the first review provides a comprehensive assessment of augmented reality technologies, including the different techniques available for the visualization of virtual content (11 papers revised); the second review collects studies with bioengineering content that highlight the research trend in robotic vascular surgery, excluding works focused only on the clinical use of commercially available robotic systems (15 papers revised). Technological flow is constant and further advances in imaging techniques and hardware components will inevitably bring new tools for a clinical translation of innovative therapeutic strategies in vascular surgery
Advanced cranial navigation
Neurosurgery is performed with extremely low margins of error. Surgical inaccuracy may
have disastrous consequences. The overall aim of this thesis was to improve accuracy in
cranial neurosurgical procedures by the application of new technical aids. Two technical
methods were evaluated: augmented reality (AR) for surgical navigation (Papers I-II) and the
optical technique of diffuse reflectance spectroscopy (DRS) for real-time tissue identification
(Papers III-V).
Minimally invasive skull-base endoscopy has several potential benefits compared to
traditional craniotomy, but approaching the skull base through this route implies that at-risk
organs and surgical targets are covered by bone and out of the surgeon’s direct line of sight.
In Paper I, a new application for AR-navigated endoscopic skull-base surgery, based on an
augmented-reality surgical navigation (ARSN) system, was developed. The accuracy of the
system, defined by mean target registration error (TRE), was evaluated and found to be
0.55±0.24 mm, the lowest value reported error in the literature.
As a first step toward the development of a cranial application for AR
navigation, in Paper II this ARSN system was used to enable insertions of biopsy needles
and external ventricular drainages (EVDs). The technical accuracy (i.e., deviation from the
target or intended path) and efficacy (i.e., insertion time) were assessed on a 3D-printed
realistic, anthropomorphic skull and brain phantom; Thirty cranial biopsies and 10 EVD
insertions were performed. Accuracy for biopsy was 0.8±0.43 mm with a median insertion
time of 149 (87-233) seconds, and for EVD accuracy was 2.9±0.8 mm at the tip with a median
angular deviation of 0.7±0.5° and a median insertion time of 188 (135-400) seconds.
Glial tumors grow diffusely in the brain, and patient survival is correlated with
the extent of tumor removal. Tumor borders are often invisible. Resection beyond borders as
defined by conventional methods may further improve a patient’s prognosis. In Paper III,
DRS was evaluated for discrimination between glioma and normal brain tissue ex vivo. DRS
spectra and histology were acquired from 22 tumor samples and 9 brain tissue samples
retrieved from 30 patients. Sensitivity and specificity for the detection of low-grade gliomas
were 82.0% and 82.7%, respectively, with an AUC of 0.91.
Acute ischemic stroke caused by large vessel occlusion is treated with
endovascular thrombectomy, but treatment failure can occur when clot composition and
thrombectomy technique are mismatched. Intra-procedural knowledge of clot composition
could guide the choice of treatment modality. In Paper IV, DRS, in vivo, was evaluated for
intravascular clot characterization. Three types of clot analogs, red blood cell (RBC)-rich,
fibrin-rich and mixed clots, were injected into the external carotids of a domestic pig. An
intravascular DRS probe was used for in-situ measurements of clots, blood, and vessel walls,
and the spectral data were analyzed. DRS could differentiate clot types, vessel walls, and
blood in vivo (p<0,001). The sensitivity and specificity for detection were 73.8% and 98.8%
for RBC clots, 100% and 100% for mixed clots, and 80.6% and 97.8% for fibrin clots,
respectively.
Paper V evaluated DRS for characterization of human clot composition ex
vivo: 45 clot units were retrieved from 29 stroke patients and examined with DRS and
histopathological evaluation. DRS parameters correlated with clot RBC fraction (R=81,
p<0.001) and could be used for the classification of clot type with sensitivity and specificity
rates for the detection of RBC-rich clots of 0.722 and 0.846, respectively. Applied in an
intravascular probe, DRS may provide intra-procedural information on clot composition to
improve endovascular thrombectomy efficiency
Proof of Concept: Wearable Augmented Reality Video See-Through Display for Neuro-Endoscopy
In mini-invasive surgery and in endoscopic procedures, the surgeon operates without a direct visualization of the patient’s anatomy. In image-guided surgery, solutions based on wearable augmented reality (AR) represent the most promising ones. The authors describe the characteristics that an ideal Head Mounted Display (HMD) must have to guarantee safety and accuracy in AR-guided neurosurgical interventions and design the ideal virtual content for guiding crucial task in neuro endoscopic surgery. The selected sequence of AR content to obtain an effective guidance during surgery is tested in a Microsoft Hololens based app
Augmented reality as a tool to guide psi placement in pelvic tumor resections
Patient-specific instruments (PSIs) have become a valuable tool for osteotomy guidance in
complex surgical scenarios such as pelvic tumor resection. They provide similar accuracy to surgical
navigation systems but are generally more convenient and faster. However, their correct placement
can become challenging in some anatomical regions, and it cannot be verified objectively during
the intervention. Incorrect installations can result in high deviations from the planned osteotomy,
increasing the risk of positive resection margins. In this work, we propose to use augmented reality
(AR) to guide and verify PSIs placement. We designed an experiment to assess the accuracy provided
by the system using a smartphone and the HoloLens 2 and compared the results with the conventional
freehand method. The results showed significant differences, where AR guidance prevented high
osteotomy deviations, reducing maximal deviation of 54.03 mm for freehand placements to less
than 5 mm with AR guidance. The experiment was performed in two versions of a plastic threedimensional
(3D) printed phantom, one including a silicone layer to simulate tissue, providing
more realism. We also studied how differences in shape and location of PSIs affect their accuracy,
concluding that those with smaller sizes and a homogeneous target surface are more prone to errors.
Our study presents promising results that prove AR’s potential to overcome the present limitations
of PSIs conveniently and effectively.This research was funded by project PI18/01625 (Ministerio de Ciencia e Innovación, Instituto
de Salud Carlos III and European Regional Development Fund “Una manera de hacer Europa”)
Image overlay surgery based on augmented reality : a systematic review
Acknowledgements We thank the staff of the Medical Library of the University of Aberdeen for their advice and Prof. Jennifer Cleland and Dr Jenny Gregory for discussion and support. This work was funded by the Roland Sutton Academic Trust (0053/R/17) and an Elphinstone PhD Scholarship from the University of Aberdeen.Postprin
A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future
none4openZaffino, Paolo; Moccia, Sara; De Momi, Elena; Spadea, Maria FrancescaZaffino, Paolo; Moccia, Sara; De Momi, Elena; Spadea, Maria Francesc
a computer assisted robotic platform for vascular procedures exploiting 3d us based tracking
AbstractBackground: Cardiovascular diseases are the first cause of death globally: an estimated 17.5 million people died in 2012. By combining the benefits of magnetic navigation and ultrasound (US) imaging, the authors proposed a robotic platform (i.e. the MicroVAST platform) for intravascular medical procedures.Methods: A 3D imaging US-based tracking algorithm is implemented for the navigation of a magnetic-dragged soft-tethered device. Tests were performed to evaluate the algorithm in terms of tracking error and precision of locomotion.Results: The 3D imaging US-based algorithm tracked the endovascular device with an error of 6.4 ± 2.8 pixels and a mean displacement between the endovascular device and the preoperative path of 13.6 ± 4.5 mm (computational time of 12.2 ± 1.5 ms and 30.7 ± 6.1 matched features).Conclusions: The MicroVAST platform includes innovative solutions for navigation allowing for an assisted magnetic locomotion of medical devices in the cardiovascular district by combining a 3D ima..
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