Abstract
ObjectiveTo verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.Materials and MethodsIn this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.ResultsThe navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.ConclusionThe self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute.
Highlights
Endoscopic sinus surgery techniques have expanded and are used to treat orbital and skull base diseases
In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery
Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons
Summary
Endoscopic sinus surgery techniques have expanded and are used to treat orbital and skull base diseases. Based on our review of the literature and personal experience, we determined that navigational systems fail for the following reasons: (1) it is difficult for doctors to match the tomographic image on the screen to the actual structures in the operated area, especially for doctors with less experience (Fig 1); (2) in conventional navigation (C-N) systems, doi:10.1371/journal.pone.0146996.g002 images are displayed on another screen, so the surgeon has to look away from the surgical field when the anatomical location is being defined, which can be dangerous during key surgical steps [3]; and (3) a great amount of time is spent repeatedly verifying surgical sites using a probe during the operation Due to these limitations, we developed an augmented reality (AR)-based navigation system for endoscopic sinus and skull base surgery. We used a series of experiments to evaluate the accuracy of our AR navigation (AR-N) system and to demonstrate its advantages, analyze its benefits to surgeons, and determine its clinical feasibility
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