Monocular Endoscope Video-based Augmented Reality for Transoral Laryngeal Tumor Resection Surgery

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 three-dimensional (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.

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Augmented reality head-mounted display–based incision planning in cranial neurosurgery: a prospective pilot study

Neurosurgical FOCUS ◽

10.3171/2021.5.focus20735 ◽

2021 ◽

Vol 51 (2) ◽

pp. E3

Author(s):

Michael E. Ivan ◽

Daniel G. Eichberg ◽

Long Di ◽

Ashish H. Shah ◽

Evan M. Luther ◽

...

Keyword(s):

Pilot Study ◽

Augmented Reality ◽

Tumor Resection ◽

Small Pilot Study ◽

Surgical Workflow ◽

Head Mounted Display ◽

Prospective Pilot Study ◽

Brain Tumor Resection ◽

Craniotomy For Tumor Resection ◽

Overlap Area

OBJECTIVE Monitor and wand–based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to “check the navigation” on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions. Augmented reality (AR) is poised to streamline these issues. The authors present the first reported prospective pilot study investigating the feasibility of using the OpenSight application with an AR head-mounted display to map out the borders of tumors in patients undergoing elective craniotomy for tumor resection, and to compare the degree of correspondence with MWBNS tracing. METHODS Eleven consecutive patients undergoing elective craniotomy for brain tumor resection were prospectively identified and underwent circumferential tumor border tracing at the time of incision planning by a surgeon wearing HoloLens AR glasses running the commercially available OpenSight application registered to the patient and preoperative MRI. Then, the same patient underwent circumferential tumor border tracing using the StealthStation S8 MWBNS. Postoperatively, both tumor border tracings were compared by two blinded board-certified neurosurgeons and rated as having an excellent, adequate, or poor correspondence degree based on a subjective sense of the overlap. Objective overlap area measurements were also determined. RESULTS Eleven patients undergoing craniotomy were included in the study. Five patient procedures were rated as having an excellent correspondence degree, 5 had an adequate correspondence degree, and 1 had poor correspondence. Both raters agreed on the rating in all cases. AR tracing was possible in all cases. CONCLUSIONS In this small pilot study, the authors found that AR was implementable in the workflow of a neurosurgery OR, and was a feasible method of preoperative tumor border identification for incision planning. Future studies are needed to identify strategies to improve and optimize AR accuracy.

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The Role of Augmented Reality in Training the Planning of Brain Tumor Resection

Augmented Reality Environments for Medical Imaging and Computer-Assisted Interventions - Lecture Notes in Computer Science ◽

10.1007/978-3-642-40843-4_26 ◽

2013 ◽

pp. 241-248 ◽

Cited By ~ 6

Author(s):

Kamyar Abhari ◽

John S. H. Baxter ◽

Elvis S. Chen ◽

Ali R. Khan ◽

Chris Wedlake ◽

...

Keyword(s):

Brain Tumor ◽

Augmented Reality ◽

Tumor Resection ◽

Brain Tumor Resection

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Primary soft tissue reconstruction after transoral laryngeal tumor resection

The Laryngoscope ◽

10.1002/lary.25019 ◽

2014 ◽

Vol 125 (5) ◽

pp. 1144-1148 ◽

Cited By ~ 1

Author(s):

Peak Woo

Keyword(s):

Soft Tissue ◽

Tumor Resection ◽

Soft Tissue Reconstruction ◽

Laryngeal Tumor ◽

Tissue Reconstruction

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Intraoperative Computed Tomography-Based Navigation with Augmented Reality for Lateral Approaches to the Spine

Brain Sciences ◽

10.3390/brainsci11050646 ◽

2021 ◽

Vol 11 (5) ◽

pp. 646

Author(s):

Mirza Pojskić ◽

Miriam Bopp ◽

Benjamin Saß ◽

Andreas Kirschbaum ◽

Christopher Nimsky ◽

...

Keyword(s):

Computed Tomography ◽

Augmented Reality ◽

Tumor Resection ◽

Pedicle Screws ◽

Lumbar Vertebra ◽

Lateral Approach ◽

Herniated Disc ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Cardiorespiratory Failure

Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

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Difficult Airway caused by a Subglottic Tumor: A Case Report

10.21203/rs.2.257/v1 ◽

2019 ◽

Author(s):

Xuefei Ye ◽

Xiaofeng Jiang ◽

Haiyan Lan ◽

Yun Yang ◽

Qingquan Lian

Keyword(s):

Case Report ◽

Difficult Airway ◽

Tumor Resection ◽

Awake Intubation ◽

Fiberoptic Intubation ◽

Intubation Attempt ◽

Anesthesia Induction ◽

Laryngeal Tumor ◽

Emergency Tracheostomy ◽

Awake Fiberoptic Intubation

Abstract Background: Securing the airway is a core skill for an anesthesiologist, the gold standard of which is tracheal intubation. Patient with subglottic tumor is a situation of difficult airways and could be a challenge for anesthesiologists. The “cannot ventilate, cannot intubate” during anesthesia induction can be lethal. So we always prepared awake approach for diagnosed difficult airway, but awake fiberoptic intubation may be also failed. Case presentation: In this case report we present a 55 years old female patient was scheduled for laryngeal tumor resection, and was planned awake intubation guided by fiber bronchoscope. After awake intubation attempt failed, emergency tracheostomy was successfully completed by ENT surgeon. After securing airway, general anesthesia was performed and the operation proceeded with laryngeal tumor resection. Conclusions: It is important that ENT surgeon must be asked to remain standby for possible need of emergency tracheostomy to prevent awake fiberoptic intubation failure. Ultrasound or computed tomography scan examination of the trachea may be useful to provide guidance for anesthesiologists to choose the appropriate endotracheal tube IDs or tracheostomy directly by measuringthe degree of airway stenosis. Keywords: Subglottic Tumor; difficult airway; ENT; anesthesia

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