Song Tianyu, Sommersperger Michael, Baran The Anh, Seibold Matthias, Navab Nassir
Chair for Computer Aided Medical Procedures & Augmented Reality, Technical University Munich, 85748 Munich, Germany.
Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD 21205, USA.
J Imaging. 2022 Nov 6;8(11):302. doi: 10.3390/jimaging8110302.
Correct positioning of the endoscope is crucial for successful hip arthroscopy. Only with adequate alignment can the anatomical target area be visualized and the procedure be successfully performed. Conventionally, surgeons rely on anatomical landmarks such as bone structure, and on intraoperative X-ray imaging, to correctly place the surgical trocar and insert the endoscope to gain access to the surgical site. One factor complicating the placement is deformable soft tissue, as it can obscure important anatomical landmarks. In addition, the commonly used endoscopes with an angled camera complicate hand-eye coordination and, thus, navigation to the target area. Adjusting for an incorrectly positioned endoscope prolongs surgery time, requires a further incision and increases the radiation exposure as well as the risk of infection. In this work, we propose an augmented reality system to support endoscope placement during arthroscopy. Our method comprises the augmentation of a tracked endoscope with a virtual augmented frustum to indicate the reachable working volume. This is further combined with an in situ visualization of the patient anatomy to improve perception of the target area. For this purpose, we highlight the anatomy that is visible in the endoscopic camera frustum and use an automatic colorization method to improve spatial perception. Our system was implemented and visualized on a head-mounted display. The results of our user study indicate the benefit of the proposed system compared to baseline positioning without additional support, such as an increased alignment speed, improved positioning error and reduced mental effort. The proposed approach might aid in the positioning of an angled endoscope, and may result in better access to the surgical area, reduced surgery time, less patient trauma, and less X-ray exposure during surgery.
内窥镜的正确定位对于髋关节镜手术的成功至关重要。只有在适当对齐的情况下,才能可视化解剖目标区域并成功进行手术。传统上,外科医生依靠骨结构等解剖标志以及术中X射线成像来正确放置手术套管针并插入内窥镜以进入手术部位。使放置过程复杂化的一个因素是可变形的软组织,因为它会遮挡重要的解剖标志。此外,常用的带角度摄像头的内窥镜会使手眼协调变得复杂,从而增加了导航到目标区域的难度。调整位置不正确的内窥镜会延长手术时间,需要进一步切开,并增加辐射暴露以及感染风险。在这项工作中,我们提出了一种增强现实系统,以支持关节镜检查期间的内窥镜放置。我们的方法包括用虚拟增强视锥对跟踪的内窥镜进行增强,以指示可到达的工作空间。这进一步与患者解剖结构的原位可视化相结合,以改善对目标区域的感知。为此,我们突出显示在内窥镜摄像头视锥中可见的解剖结构,并使用自动着色方法来改善空间感知。我们的系统在头戴式显示器上实现并可视化。我们用户研究的结果表明,与没有额外支持的基线定位相比,所提出的系统具有优势,例如提高了对齐速度、改善了定位误差并减少了心理负担。所提出的方法可能有助于带角度内窥镜的定位,并可能导致更好地进入手术区域、减少手术时间、减少患者创伤以及减少手术期间的X射线暴露。
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