Wang Jonathan, Ishida Hisashi, Usevitch David, Venkatesh Kesavan, Wang Yi, Armand Mehran, Bronheim Rachel, Jain Amit, Munawar Adnan
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA.
IEEE Trans Med Robot Bionics. 2025 Aug;7(3):1125-1138. doi: 10.1109/tmrb.2025.3589795. Epub 2025 Jul 16.
Surgical training remains a crucial milestone in modern medicine, with procedures such as laminectomy exemplifying the high risks involved. Laminectomy drilling requires precise manual control to mill bony tissue while preserving spinal segment integrity and avoiding breaches in the dura-the protective membrane surrounding the spinal cord. Despite unintended dural tears occurring in up to 11.3% of cases, no assistive tools are currently utilized to reduce this risk. Variability in patient anatomy further complicates learning for novice surgeons. This study introduces CAPTAiN, a critical anatomy-preserving and terrain-augmenting navigation system that provides layered, color-coded voxel guidance to enhance anatomical awareness during spinal drilling. CAPTAiN was evaluated against a standard non-navigated approach through 110 virtual laminectomies performed by 11 orthopedic residents and medical students. CAPTAiN significantly improved surgical completion rates of target anatomy (87.99% vs. 74.42%) and reduced cognitive load across multiple NASA-TLX domains. It also minimized performance gaps across experience levels, enabling novices to perform on par with advanced trainees. These findings highlight CAPTAiN's potential to optimize surgical execution and support skill development across experience levels. Beyond laminectomy, it demonstrates potential for broader applications across various surgical and drilling procedures, including those in neurosurgery, otolaryngology, and other medical fields.
外科手术培训仍然是现代医学中的一个关键里程碑，诸如椎板切除术等手术就体现了其中涉及的高风险。椎板切除术钻孔需要精确的手动控制，以铣削骨组织，同时保持脊柱节段的完整性，并避免硬脊膜（脊髓周围的保护膜）破裂。尽管在高达11.3%的病例中会意外发生硬脊膜撕裂，但目前尚无辅助工具用于降低这种风险。患者解剖结构的差异进一步使新手外科医生的学习变得复杂。本研究介绍了CAPTAiN，这是一种关键的解剖结构保护和地形增强导航系统，它提供分层的、颜色编码的体素引导，以增强脊柱钻孔过程中的解剖学意识。通过11名骨科住院医师和医学生进行的110次虚拟椎板切除术，将CAPTAiN与标准的非导航方法进行了评估。CAPTAiN显著提高了目标解剖结构的手术完成率（87.99%对74.42%），并降低了多个NASA-TLX领域的认知负荷。它还最大限度地缩小了不同经验水平之间的表现差距，使新手能够与高级受训者表现相当。这些发现凸显了CAPTAiN在优化手术执行以及支持不同经验水平技能发展方面的潜力。除了椎板切除术之外，它还展示了在包括神经外科、耳鼻喉科和其他医学领域的各种外科手术和钻孔程序中更广泛应用的潜力。
