Ye Jian, Chen Qingwen, Zhong Tao, Liu Jian, Gao Han
Department of Neurosurgery, Affiliated Qingyuan Hospital, Guangzhou Medical University, Qingyuan People's Hospital, Qiangyuan, China.
Department of Neurosurgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
CNS Neurosci Ther. 2025 Jan;31(1):e70217. doi: 10.1111/cns.70217.
BACKGROUND: During the course of the past two decades, head-mounted augmented reality surgical navigation (HMARSN) systems have been increasingly employed in a variety of surgical specialties as a result of both advancements in augmented reality-related technologies and surgeons' desires to overcome some drawbacks inherent to conventional surgical navigation systems. In the present time, most experimental HMARSN systems adopt overlain display (OD) that overlay virtual models and planned routes of surgical tools on corresponding physical tissues, organs, lesions, and so forth, in a surgical field so as to provide surgeons with an intuitive and direct view to gain better hand-eye coordination as well as avoid attention shift and loss of sight (LOS), among other benefits during procedures. Yet, its system accuracy, which is the most crucial performance indicator of any surgical navigation system, is difficult to ascertain because it is highly subjective and user-dependent. Therefore, the aim of this study was to review presently available experimental OD HMARSN systems qualitatively, explore how their system accuracy is affected by overlain display, and find out if such systems are suited to large-scale clinical deployment. METHOD: We searched PubMed and ScienceDirect with the following terms: head mounted augmented reality surgical navigation, and 445 records were returned in total. After screening and eligibility assessment, 60 papers were finally analyzed. Specifically, we focused on how their accuracies were defined and measured, as well as whether such accuracies are stable in clinical practice and competitive with corresponding commercially available systems. RESULTS AND CONCLUSIONS: The primary findings are that the system accuracy of OD HMARSN systems is seriously affected by a transformation between the spaces of the user's eyes and the surgical field, because measurement of the transformation is heavily individualized and user-dependent. Additionally, the transformation itself is potentially subject to changes during surgical procedures, and hence unstable. Therefore, OD HMARSN systems are not suitable for large-scale clinical deployment.
背景：在过去二十年中，由于增强现实相关技术的进步以及外科医生希望克服传统手术导航系统固有的一些缺点，头戴式增强现实手术导航（HMARSN）系统越来越多地应用于各种外科专业领域。目前，大多数实验性HMARSN系统采用叠加显示（OD），即将虚拟模型和手术工具的规划路线叠加在手术视野中的相应物理组织、器官、病变等上，以便为外科医生提供直观直接的视图，从而在手术过程中获得更好的手眼协调能力，并避免注意力转移和视线丢失（LOS）等。然而，其系统准确性作为任何手术导航系统最关键的性能指标，却难以确定，因为它具有高度主观性且依赖用户。因此，本研究的目的是对目前可用的实验性OD HMARSN系统进行定性综述，探讨其系统准确性如何受到叠加显示的影响，并查明此类系统是否适合大规模临床应用。 方法：我们使用以下术语在PubMed和ScienceDirect上进行搜索：头戴式增强现实手术导航，共返回445条记录。经过筛选和资格评估，最终分析了60篇论文。具体而言，我们关注其准确性是如何定义和测量的，以及此类准确性在临床实践中是否稳定，是否能与相应的商用系统相媲美。 结果与结论：主要发现是，OD HMARSN系统的系统准确性受到用户眼睛空间与手术视野之间变换的严重影响，因为这种变换的测量高度个体化且依赖用户。此外，这种变换本身在手术过程中可能会发生变化，因此不稳定。所以，OD HMARSN系统不适合大规模临床应用。
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