Section of Plastic and Reconstructive Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Department of Computer Science, Center for Human-Computer Interaction, Virginia Tech, Blacksburg, VA, USA.
Surg Innov. 2024 Oct;31(5):493-501. doi: 10.1177/15533506241265544. Epub 2024 Jul 26.
Plastic surgeons use loupes or operative microscope to aid in tissue dissection and anastomosis of structures. These devices have their own limitations in areas of visualization and weight. Current uses of augmented and virtual reality in surgery have been limited to operative planning and simulation. We present a proof of concept that harnesses video passthrough AR technology to augment the capabilities of loupes.
We first evaluated methods of gaze-based eye tracking to enable digital magnification. Using the Varjo XR-1 mixed reality headset, we compared discrete zoom through displayed pop-up menu vs continuous zoom through eye winking. Six participants were recruited to perform skin suturing simulation and completed a survey and interview. Next we assessed the performance and limitations of AR digital magnification. Varjo XR-3 was utilized to address the hardware limitations. Participants performed anastomotic suturing tasks with progressively finer suture, then completed a survey and interview.
There was no strong preference between zoom methods, although participants felt the discrete zoom was easier to use. Participants had difficulty determining depth and visualizing the suture due to limitations of digital magnification. Using Wilcoxon rank sum test to examine differences in system usability scale, the Phase 2 user experience had significant difference in percentile distribution ( 0.0390).
Virtual loupes may be a valuable tool for plastic surgeons, with potential for variable magnification and advanced visualization. Improvements in the hardware yielded higher ratings of system usability and user experience. Further development is needed to address the limitations of existing devices.
整形外科医生使用放大镜或手术显微镜来辅助组织解剖和结构吻合。这些设备在可视化和重量方面都有其自身的局限性。目前，增强现实和虚拟现实在手术中的应用仅限于手术规划和模拟。我们提出了一个概念验证，利用视频透视增强现实技术来增强放大镜的功能。
我们首先评估了基于注视的眼动追踪方法，以实现数字放大。使用 Varjo XR-1 混合现实耳机，我们比较了通过显示弹出菜单进行离散缩放与通过眨眼进行连续缩放。招募了 6 名参与者进行皮肤缝合模拟，并完成了一项调查和访谈。接下来，我们评估了增强现实数字放大的性能和局限性。利用 Varjo XR-3 解决硬件限制。参与者使用越来越细的缝线进行吻合缝合任务，然后完成了一项调查和访谈。
缩放方法之间没有明显的偏好，尽管参与者认为离散缩放更容易使用。由于数字放大的限制，参与者难以确定深度和可视化缝线。使用 Wilcoxon 秩和检验来检查系统可用性量表的差异，第二阶段的用户体验在百分位数分布上有显著差异（0.0390）。
虚拟放大镜可能是整形外科医生的一种有价值的工具，具有可变放大和高级可视化的潜力。硬件的改进提高了系统可用性和用户体验的评分。需要进一步开发来解决现有设备的局限性。
