Augmented reality in gynecologic laparoscopic surgery: development, evaluation of accuracy and clinical relevance of a device useful to identify ureters during surgery
Augmented reality in gynecologic laparoscopic surgery: development, evaluation of accuracy and clinical relevance of a device useful to identify ureters during surgery
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DOI：
10.1007/s00464-019-06855-2
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发表时间：
2020-03-01
影响因子：
3.1
通讯作者：
Marescaux, Jacques
中科院分区：
文献类型：
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作者：
Akladios, Cherif;Gabriele, Victor;Marescaux, Jacques
目的开发和评价一种基于增强现实(AR)的无创手术辅助技术在动物模型上的输尿管检测。方法在2头猪上进行实验模型制作，确定AR显示输尿管的最佳条件后，每隔1周对3头猪进行3次手术。介入包括识别输尿管，有无AR的协助。在干预结束时，将夹子放在AR建议的输尿管上以评估其准确性。通过锥形束计算机断层扫描，我们测量了对比后的输尿管与夹子之间的距离。记录了13个视频，允许随后评估该设备的临床相关性。结果证实了该技术的可行性。输尿管定位精度的误差范围为1.77 mm(+/-1.56 mm)。为了评估AR辅助输尿管检测的相关性和准确性，58名妇科外科医生观看了视频，然后进行了询问。在获得的754个反应中(13个视频x 58个外科医生)，31.2%的病例能直接看到输尿管，而AR的比率为81.7%(p值3.62×10(-7))。当观察已经做过一次或两次手术的猪时，直视的病例中只有16%的病例能识别出输尿管，而AR的病例中有76.1%的病例能识别输尿管(p值5.48x10(-19))。此外，67%的外科医生认为AR能让他们更好地识别输尿管，61%的外科医生认为AR重建是准确的。结论该AR装置对输尿管的检出具有较高的精度，受到外科医生的好评。这种手术辅助系统可能有助于执行困难的程序，例如，对于过去经历过多次手术的患者。
Objective To develop and evaluate a non-invasive surgical assistance based on augmented reality (AR) in the detection of ureters on animal model. Method After an experimental prototyping step on two pigs to determine the optimal conditions for visualization of the ureter in AR, three pigs were operated three times at 1 week intervals. The intervention consisted of an identification of the ureter, with and without the assistance of AR. At the end of the intervention, a clip was placed on the AR-proposed ureter to evaluate its accuracy. By doing a cone beam computed tomography, we measured the distance between the contrasted ureter and the clips in the acquired volume. Thirteen videos were recorded, allowing subsequent evaluation of the clinical relevance of the device. Results The feasibility of the technique has been confirmed. The margin of error was 1.77 mm (+/- 1.56 mm) for ureter localization accuracy. In order to evaluate the perceived relevance and accuracy in the detection of AR-assisted ureter, 58 gynecological surgeons were shown the videos then questioned. Of the 754 responses obtained (13 videos x 58 surgeons), the ureter was identified in direct vision in 31.2% of cases versus 81.7% in AR (p value 3.62 x 10(-7)). When looking at pigs that had already had one or two operations, the ureter was identified in only 16% of cases with direct vision compared to 76.1% with AR (p-value 5.48 x 10(-19)). In addition, 67% of surgeons felt that AR allowed them to better identify the ureters and 61% that AR reconstruction was accurate. Conclusion This first AR device showed a satisfactory precision in the detection of ureters with a favorable opinion of surgeons. This surgical assistance system could be helpful in the performance of difficult procedures, for example in the case of patients, which have undergone multiple surgeries in the past.