Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology & Erasmus University Medical Center Rotterdam, Leiden, The Netherlands.
Surg Innov. 2024 Dec;31(6):646-658. doi: 10.1177/15533506241290412. Epub 2024 Oct 7.
This systematic review investigates of Augmented Reality (AR) systems used in minimally invasive surgery of deformable organs, focusing on initial registration, dynamic tracking, and visualization. The objective is to acquire a comprehensive understanding of the current knowledge, applications, and challenges associated with current AR-techniques, aiming to leverage these insights for developing a dedicated AR pulmonary Video or Robotic Assisted Thoracic Surgery (VATS/RATS) workflow.
A systematic search was conducted within Embase, Medline (Ovid) and Web of Science on April 16, 2024, following the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA). The search focused on intraoperative AR applications and intraoperative navigational purposes for deformable organs. Quality assessment was performed and studies were categorized according to initial registration and dynamic tracking methods.
33 articles were included, of which one involved pulmonary surgery. Studies used both manual and (semi-) automatic registration methods, established through anatomical landmark-based, fiducial-based, or surface-based techniques. Diverse outcome measures were considered, including surgical outcomes and registration accuracy. The majority of studies that reached an registration accuracy below 5 mm applied surface-based registration.
AR can potentially aid surgeons with real-time navigation and decision making during anatomically complex minimally invasive procedures. Future research for pulmonary applications should focus on exploring surface-based registration methods, considering their non-invasive, marker-less nature, and promising accuracy. Additionally, vascular-labeling-based methods are worth exploring, given the importance and relative stability of broncho-vascular anatomy in pulmonary VATS/RATS. Assessing clinical feasibility of these approaches is crucial, particularly concerning registration accuracy and potential impact on surgical outcomes.
本系统评价研究了用于可变形器官微创手术的增强现实（AR）系统，重点关注初始注册、动态跟踪和可视化。目的是全面了解当前与 AR 技术相关的知识、应用和挑战，旨在利用这些见解开发专门的 AR 肺部视频或机器人辅助胸腔手术（VATS/RATS）工作流程。
2024 年 4 月 16 日，在 Embase、Medline（Ovid）和 Web of Science 中进行了系统搜索，遵循系统评价和荟萃分析的首选报告项目（PRISMA）。搜索重点是针对可变形器官的术中 AR 应用和术中导航目的。进行了质量评估，并根据初始注册和动态跟踪方法对研究进行了分类。
共纳入 33 篇文章，其中 1 篇涉及肺部手术。研究采用了手动和（半）自动注册方法，通过解剖标志、基准或基于表面的技术建立。考虑了多种结果测量指标，包括手术结果和注册准确性。大多数达到 5 毫米以下注册准确性的研究都应用了基于表面的注册。
AR 有可能帮助外科医生在解剖结构复杂的微创手术中进行实时导航和决策。未来在肺部应用的研究应重点探索基于表面的注册方法，考虑到它们的非侵入性、无标记性质以及有前途的准确性。此外，血管标记的方法值得探索，因为支气管血管解剖结构在肺部 VATS/RATS 中的重要性和相对稳定性。评估这些方法的临床可行性至关重要，特别是关于注册准确性和对手术结果的潜在影响。
