Tang Z N, Hui Y, Hu L H, Yu Y, Zhang W B, Peng X
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Dec 18;52(6):1124-1129. doi: 10.19723/j.issn.1671-167X.2020.06.023.
To explore the application of mixed reality technique for the surgery of oral and maxillofacial tumors.
In this study, patients with a diagnosis of an oral and maxillofacial tumor who were referred to Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from December 2018 to January 2020 were selected. The preoperative contrast-enhanced computed tomography data of the patients were imported into StarAtlas Holographic Medical Imaging System (Visual 3D Corp., Beijing, China). Three-dimensional (3D) model of tumor and key structures, such as skeleton and vessels were reconstructed to three-dimensionally present the spatial relationship between them, followed with the key structures delineation and preoperative virtual surgical planning. By using mixed reality technique, the real-time 3D model was displayed stereotactically in the surgical site. While keeping sterile during operation, the surgeon could use simple gestures to adjust the 3D model, and observed the location, range, and size of tumor and the key structures adjacent to the tumor. Mixed reality technique was used to assist the operation: 3D model registration was performed for guidance before tumor excision; intraoperative real-time verification was performed during tumor exposure and after excision of the tumor. The Likert scale was used to evaluate the application of mixed reality technique after the operation.
Eight patients underwent mixed reality assisted tumor resection, and all of them successfully completed the operation. The average time of the 3D model registration was 12.0 minutes. In all the cases, the surgeon could intuitively and three-dimensionally observe the 3D model of the tumor and the surrounding anatomical structures, and could adjust the model during the operation. The results of the Likert scale showed that mixed reality technique got high scores in terms of perceptual accuracy, helping to locate the anatomical parts, the role of model guidance during surgery, and the potential for improving surgical safety (4.22, 4.19, 4.16, and 4.28 points respectively). Eight patients healed well without perioperative complications.
By providing real-time stereotactic visualization of anatomy of surgical site and guiding the operation process through 3D model, mixed reality technique could improve the accuracy and safety of the excision of oral and maxillofacial tumors.
探讨混合现实技术在口腔颌面肿瘤手术中的应用。
本研究选取2018年12月至2020年1月就诊于北京大学口腔医学院口腔颌面外科诊断为口腔颌面肿瘤的患者。将患者术前增强CT数据导入StarAtlas全息医学影像系统（中国北京视见三维科技有限公司）。重建肿瘤及骨骼、血管等关键结构的三维（3D）模型，以三维方式呈现它们之间的空间关系，随后进行关键结构勾勒和术前虚拟手术规划。利用混合现实技术，将实时3D模型立体显示于手术部位。手术过程中保持无菌，术者可通过简单手势调整3D模型，观察肿瘤的位置、范围、大小以及肿瘤相邻的关键结构。混合现实技术辅助手术：在肿瘤切除前进行3D模型配准以提供指导；在肿瘤暴露过程中及肿瘤切除后进行术中实时验证。术后采用Likert量表评估混合现实技术的应用情况。
8例患者接受混合现实辅助肿瘤切除术，均成功完成手术。3D模型配准平均时间为12.0分钟。所有病例中，术者均可直观地三维观察肿瘤及周围解剖结构的3D模型，并在手术过程中进行调整。Likert量表结果显示，混合现实技术在感知准确性、帮助定位解剖部位、手术中模型指导作用以及提高手术安全性潜力方面得分较高（分别为4.22分、4.19分、4.16分和4.28分）。8例患者愈合良好，无围手术期并发症。
混合现实技术通过提供手术部位解剖结构的实时立体可视化并通过3D模型指导手术过程，可提高口腔颌面肿瘤切除的准确性和安全性。
