INTEGRATED THEATRES
headset, which in turn overlays the model onto what the surgeon can see in the operating theatre. Clinical staff are able to manipulate these AR images through hand gestures to make any fine adjustments and correctly line up the model with surgical landmarks on the patient’s limbs, such as the knee joint or ankle bone. Dr Amiras said: “After seeing some videos of the HoloLens I contacted Dr Pratt to see if we could use this technology to bring the information from the CT directly to the operating theatre.
“St Mary’s Hospital is a major trauma
centre, giving us the opportunity to try and improve the pre-operative planning for reconstructive flaps. “Over time, the scanning protocol has been optimised to give excellent images of the anatomy, however, at first we had to rely on rough measurements of anatomical landmarks taken from 3D CT reconstructions to guide surgery. Now, using the HoloLens, we can identify where the blood vessels are in 3D space and use virtual 3D arrows to guide the surgeon. “Currently, data preparation is a time consuming process, but in the future much of this could be automated, with
We are one of the first groups in the world to use the HoloLens successfully in the operating theatre. Dr Philip Pratt
the consultant radiologist checking the accuracy of the model against the original scan.
“I think this is a great example of what can be achieved in an Academic Health Science Centre.”
The surgeon’s view Mr Jon Simmons, a plastic and reconstructive surgeon at ICHNT, led the team who carried out the procedures using the HoloLens headset and augmented reality models. The cases ranged from a 41-year-old man who had sustained leg injuries during a car accident, to an 85-year-old woman with a compound fractured ankle. The surgical teams reported the HoloLens to be a powerful tool in the theatre, with the approach being more reliable and less time-consuming than
the ultrasound method of locating blood vessels.
“The application of AR technology in the operating theatre has some really exciting possibilities,” said Mr Simmons. “It could help to simplify and improve the accuracy of some elements of reconstructive procedures. “While the technology can’t replace the skill and experience of the clinical team, it could potentially help to reduce the time a patient spends under anaesthetic and reduce the margin for error. We hope that it will allow us to provide more tailored surgical solutions for individual patients.” The group highlights a few limitations with the technology, which could include errors during the modelling stages as well as the potential for the overlaid model to be misaligned.
In addition, the case studies so far have been based on the leg, which has a number of clearly visible surgical ‘landmarks’, such as the ankle or knee. Areas without these rigid landmarks, such as abdomen, may be more complicated with a greater potential for movement of blood vessels. However, the researchers are confident that, once refined, the approach could be applied to other areas of reconstructive surgery requiring tissue flaps, such as breast reconstruction following mastectomy. The next steps include trialling the technology in a larger set of patients, with procedures carried out by teams at multiple centres.
A: AR overlay of models as viewed from remote HoloLens. B: Confirmation of perforator location with audible Doppler ultrasonography. C: Overlay with bounding box; arrows highlighting position of D: medial sural and E: posterior tibial perforators.
Dr Pratt added: “In future we hope to automate the process further. We can use software to improve the alignment and will attach markers to the patient when they have the scan, with the same markers present during the operation to use as additional points of reference. He concluded: “There are a number
of areas we would like to explore, and further improvements are needed, but the small case series has shown that for reconstructive surgery, this seems to be a valuable tool in the operating theatre.”
References 1
n
Through the HoloLens looking glass: augmented reality for extremity reconstruction surgery using 3D vascular models with perforating vessels: https://eurradiolexp.
springeropen.com/articles/
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