Dataset Information

Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial.

ABSTRACT:

Objective

Endoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure.

Methods

One hundred patients with chronic sinus disease were operated on using either a conventional navigation software (n = 52, non-AR, control group) or a navigation software incorporating AR elements (n = 48, AR, intervention group). Incidence of postoperative complications, duration of surgery, surgeon-reported benefit from the navigation system and patient-reported postoperative rehabilitation were assessed.

Results

The surgeons reported a higher benefit during surgery, used the navigation system for more surgical steps and spent longer time with preoperative image analysis when using the AR system as compared with the non-AR system. No significant differences were seen in terms of postoperative complications, target registration error, operation time and postoperative rehabilitation.

Conclusion

The AR enhanced navigation software shows a high acceptance by sinus surgeons in different stages of surgical training and offers potential benefits during surgery without affecting the duration of the operation or the incidence of postoperative complications.

Level of evidence

1b.

SUBMITTER: Linxweiler M

PROVIDER: S-EPMC7444769 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Publications

Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial.

Linxweiler Maximilian M Pillong Lukas L Kopanja Dragan D Kühn Jan P JP Wagenpfeil Stefan S Radosa Julia C JC Wang Jingming J Morris Luc G T LGT Al Kadah Basel B Bochen Florian F Körner Sandrina S Schick Bernhard B

Laryngoscope investigative otolaryngology 20200807 4

<h4>Objective</h4>Endoscopic sinus surgery represents the gold standard for surgical treatment of chronic sinus diseases. Thereby, navigation systems can be of distinct use. In our study, we tested the recently developed KARL STORZ NAV1 SinusTracker navigation software that incorporates elements of augmented reality (AR) to provide a better preoperative planning and guidance during the surgical procedure.<h4>Methods</h4>One hundred patients with chronic sinus disease were operated on using eithe ...[more]

PMID: 32864433

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Project description:Functional Endoscopic Sinus Surgery (FESS) is a challenging procedure for otolaryngologists and is the main surgical approach for treating chronic sinusitis, to remove nasal polyps and open up passageways. To reach the source of the problem and to ultimately remove it, the surgeons must often remove several layers of cartilage and tissues. Often, the cartilage occludes or is within a few millimeters of critical anatomical structures such as nerves, arteries and ducts. To make FESS safer, surgeons use navigation systems that register a patient to his/her CT scan and track the position of the tools inside the patient. Current navigation systems, however, suffer from tracking errors greater than 1 mm, which is large when compared to the scale of the sinus cavities, and errors of this magnitude prevent from accurately overlaying virtual structures on the endoscope images. In this paper, we present a method to facilitate this task by 1) registering endoscopic images to CT data and 2) overlaying areas of interests on endoscope images to improve the safety of the procedure. First, our system uses structure from motion (SfM) to generate a small cloud of 3D points from a short video sequence. Then, it uses iterative closest point (ICP) algorithm to register the points to a 3D mesh that represents a section of a patients sinuses. The scale of the point cloud is approximated by measuring the magnitude of the endoscope's motion during the sequence. We have recorded several video sequences from five patients and, given a reasonable initial registration estimate, our results demonstrate an average registration error of 1.21 mm when the endoscope is viewing erectile tissues and an average registration error of 0.91 mm when the endoscope is viewing non-erectile tissues. Our implementation SfM + ICP can execute in less than 7 seconds and can use as few as 15 frames (0.5 second of video). Future work will involve clinical validation of our results and strengthening the robustness to initial guesses and erectile tissues.

Project description:BackgroundSeptic shock is a low-frequency but high-stakes condition in children requiring prompt resuscitation, which makes it an important target for simulation-based education.ObjectiveIn this study, we aimed to design and implement an augmented reality app (PediSepsisAR) for septic shock simulation, test the feasibility of measuring the timing and volume of fluid administration during septic shock simulation with and without PediSepsisAR, and describe PediSepsisAR as an educational tool. We hypothesized that we could feasibly measure our desired data during the simulation in 90% of the participants in each group. With regard to using PediSepsisAR as an educational tool, we hypothesized that the PediSepsisAR group would report that it enhanced their awareness of simulated patient blood flow and would more rapidly verbalize recognition of abnormal patient status and desired management steps.MethodsWe performed a randomized controlled feasibility trial with a convenience sample of pediatric care providers at a large tertiary care pediatric center. Participants completed a prestudy questionnaire and were randomized to either the PediSepsisAR or control (traditional simulation) arms. We measured the participants' time to administer 20, 40, and 60 cc/kg of intravenous fluids during a septic shock simulation using each modality. In addition, facilitators timed how long participants took to verbalize they had recognized tachycardia, hypotension, or septic shock and desired to initiate the sepsis pathway and administer antibiotics. Participants in the PediSepsisAR arm completed a poststudy questionnaire. We analyzed data using descriptive statistics and a Wilcoxon rank-sum test to compare the median time with event variables between groups.ResultsWe enrolled 50 participants (n=25 in each arm). The timing and volume of fluid administration were captured in all the participants in each group. There was no statistically significant difference regarding time to administration of intravenous fluids between the two groups. Similarly, there was no statistically significant difference between the groups regarding time to verbalized recognition of patient status or desired management steps. Most participants in the PediSepsisAR group reported that PediSepsisAR enhanced their awareness of the patient's perfusion.ConclusionsWe developed an augmented reality app for use in pediatric septic shock simulations and demonstrated the feasibility of measuring the volume and timing of fluid administration during simulation using this modality. In addition, our findings suggest that PediSepsisAR may enhance participants' awareness of abnormal perfusion.

Dataset Information

Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial.

Objective

Methods

Results

Conclusion

Level of evidence

Publications

Augmented reality-enhanced navigation in endoscopic sinus surgery: A prospective, randomized, controlled clinical trial.

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