*Charité - Universitätsmedizin Berlin, Berlin, Germany †Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany ‡Berlin Institute of Health, Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Experimental Surgery and Regenerative Medicine, Berlin, Germany §Image Knowledge Gestaltung, Berlin, Germany.
Ann Surg. 2017 Nov;266(5):706-712. doi: 10.1097/SLA.0000000000002448.
OBJECTIVE: The paper evaluates the application of a mixed reality (MR) headmounted display (HMD) for the visualization of anatomical structures in complex visceral-surgical interventions. A workflow was developed and technical feasibility was evaluated. SUMMARY OF BACKGROUND DATA: Medical images are still not seamlessly integrated into surgical interventions and, thus, remain separated from the surgical procedure.Surgeons need to cognitively relate 2-dimensional sectional images to the 3-dimensional (3D) during the actual intervention. MR applications simulate 3D images and reduce the offset between working space and visualization allowing for improved spatial-visual approximation of patient and image. METHODS: The surgeon's field of vision was superimposed with a 3D-model of the patient's relevant liver structures displayed on a MR-HMD. This set-up was evaluated during open hepatic surgery. RESULTS: A suitable workflow for segmenting image masks and texture mapping of tumors, hepatic artery, portal vein, and the hepatic veins was developed. The 3D model was positioned above the surgical site. Anatomical reassurance was possible simply by looking up. Positioning in the room was stable without drift and minimal jittering. Users reported satisfactory comfort wearing the device without significant impairment of movement. CONCLUSION: MR technology has a high potential to improve the surgeon's action and perception in open visceral surgery by displaying 3D anatomical models close to the surgical site. Superimposing anatomical structures directly onto the organs within the surgical site remains challenging, as the abdominal organs undergo major deformations due to manipulation, respiratory motion, and the interaction with the surgical instruments during the intervention. A further application scenario would be intraoperative ultrasound examination displaying the image directly next to the transducer. Displays and sensor-technologies as well as biomechanical modeling and object-recognition algorithms will facilitate the application of MR-HMD in surgery in the near future.
目的：本文评估了混合现实（MR）头戴式显示器（HMD）在复杂内脏手术干预中可视化解剖结构的应用。开发了一种工作流程并评估了其技术可行性。
背景资料概要：医学图像仍未无缝集成到手术干预中，因此仍然与手术过程分离。外科医生在实际干预过程中需要认知地将二维切片图像与三维（3D）相关联。MR 应用程序模拟 3D 图像并减少工作空间和可视化之间的偏移，从而允许对患者和图像进行更好的空间视觉近似。
方法：将患者相关肝结构的 3D 模型叠加在外科医生的视野上，该模型显示在 MR-HMD 上。这种设置在开放性肝手术中进行了评估。
结果：开发了一种用于分割图像掩模和对肿瘤、肝动脉、门静脉和肝静脉进行纹理映射的合适工作流程。3D 模型位于手术部位上方。只需抬头即可进行解剖确认。在房间内的定位稳定，无漂移且抖动最小。用户报告佩戴该设备舒适度满意，且运动不受重大影响。
结论：MR 技术具有通过在靠近手术部位显示 3D 解剖模型来改善开放内脏手术中外科医生的动作和感知的巨大潜力。将解剖结构直接叠加到手术部位内的器官上仍然具有挑战性，因为腹部器官由于操作、呼吸运动以及与手术器械的相互作用而在手术过程中会发生重大变形。另一个应用场景是术中超声检查，将图像直接显示在换能器旁边。显示和传感器技术以及生物力学建模和物体识别算法将促进 MR-HMD 在不久的将来在手术中的应用。
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