Abstract
PurposeMixed reality (MR) is being evaluated as a visual tool for surgical navigation. Current literature presents unclear results on intraoperative accuracy using the Microsoft HoloLens 1®. This study aims to assess the impact of the surgeon’s sightline in an inside-out marker-based MR navigation system for open surgery.MethodsSurgeons at Akershus University Hospital tested this system. A custom-made phantom was used, containing 18 wire target crosses within its inner walls. A CT scan was obtained in order to segment all wire targets into a single 3D-model (hologram). An in-house software application (CTrue), developed for the Microsoft HoloLens 1, uploaded 3D-models and automatically registered the 3D-model with the phantom. Based on the surgeon’s sightline while registering and targeting (free sightline /F/or a strictly perpendicular sightline /P/), 4 scenarios were developed (FF-PF-FP-PP). Target error distance (TED) was obtained in three different working axes-(XYZ).ResultsSix surgeons (5 males, age 29–62) were enrolled. A total of 864 measurements were collected in 4 scenarios, twice. Scenario PP showed the smallest TED in XYZ-axes mean = 2.98 mm ± SD 1.33; 2.28 mm ± SD 1.45; 2.78 mm ± SD 1.91, respectively. Scenario FF showed the largest TED in XYZ-axes with mean = 10.03 mm ± SD 3.19; 6.36 mm ± SD 3.36; 16.11 mm ± SD 8.91, respectively. Multiple comparison tests, grouped in scenarios and axes, showed that the majority of scenario comparisons had significantly different TED values (p < 0.05). Y-axis always presented the smallest TED regardless of scenario tested.ConclusionA strictly perpendicular working sightline in relation to the 3D-model achieves the best accuracy results. Shortcomings in this technology, as an intraoperative visual cue, can be overcome by sightline correction. Incidentally, this is the preferred working angle for open surgery.
Highlights
The potential of mixed reality (MR) has recently gained more attention in multiple surgical fields together with the appearance of Microsoft HoloLens 1®, as this device is commercially available and its technology can add new layers of anatomical information to the working field [1,2,3,4]
The fatty tissue connecting the bowel to the body contains all of these pathways together with vital blood vessels, which are mostly concealed by the thickness of the fat [11]
We mainly find heterogenous results in the literature describing the accuracy of the HoloLens, using mathematical methods [16, 17]
Summary
The potential of mixed reality (MR) has recently gained more attention in multiple surgical fields together with the appearance of Microsoft HoloLens 1®, as this device is commercially available and its technology can add new layers of anatomical information to the working field [1,2,3,4]. The fatty tissue connecting the bowel to the body (the mesentery) contains all of these pathways together with vital blood vessels, which are mostly concealed by the thickness of the fat [11] This visual obstacle is the main reason why most of the compromises in quality of surgery are made, due to higher risks for bleedings and other complications [12]. The growing body of scientific evidence states that more extensive surgery (e.g., extended lymphadenectomy) can provide better disease-free survival for patients [13, 14] For these reasons, it seems that a viable surgical navigation system could facilitate more extensive surgery without compromising safety [15], provided acceptable accuracy. This is why we introduce in this study a perceptual variable: the surgeon’s sightline
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