Navigation Assistance Research Articles

Ensuring Driving and Road Safety of Autonomous Vehicles Using a Control Optimiser Interaction Framework Through Smart “Thing” Information Sensing and Actuation

Road safety through point-to-point interaction autonomous vehicles (AVs) assimilate different communication technologies for reliable and persistent information sharing. Vehicle interaction resilience and consistency require novel sharing knowledge for retaining driving and pedestrian safety. This article proposes a control optimiser interaction framework (COIF) for organising information transmission between the AV and interacting “Thing”. The framework relies on the neuro-batch learning algorithm to improve the consistency measure’s adaptability with the interacting “Things”. In the information-sharing process, the maximum extraction and utilisation are computed to track the AV with precise environmental knowledge. The interactions are batched with the type of traffic information obtained, such as population, accidents, objects, hindrances, etc. Throughout travel, the vehicle’s learning rate and the surrounding environment’s familiarity with it are classified. The learning neurons are connected to the information actuated and sensed by the AV to identify any unsafe vehicle activity in unknown or unidentified scenarios. Based on the risk and driving parameters, the safe and unsafe activity of the vehicles is categorised with a precise learning rate. Therefore, minor changes in vehicular decisions are monitored, and driving control is optimised accordingly to retain 7.93% of navigation assistance through a 9.76% high learning rate for different intervals.

Enhanced lightweight infrared object detection algorithm for assistive navigation in visually impaired individuals

Enhanced lightweight infrared object detection algorithm for assistive navigation in visually impaired individuals

Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care.

Telemedicine and Access to Elective Cholecystectomy for Socially Vulnerable Adults

Socially vulnerable patients with symptomatic cholelithiasis are more likely to face barriers to accessing surgical care. This barrier to access can lead to delays in treatment, the need for emergent cholecystectomy, and worse outcomes. To determine the effectiveness of telemedicine vs in-person surgical consultation on access to elective cholecystectomy in socially vulnerable populations and to evaluate the association of scheduling navigation with access to elective cholecystectomy in these populations. This pilot randomized clinical trial conducted in a single academic center enrolled 60 adults from February 1, 2023, to February 21, 2024, with 3-month follow-up of clinical outcomes. Data were also collected retrospectively on a comparison group of 32 patients referred from June 30 to December 29, 2022. Adults with social vulnerability, such as being non-White or Hispanic or having nonprivate insurance or low income, with a diagnosis of symptomatic cholelithiasis and referral for outpatient surgical consultation were included. All trial participants were randomized to the telemedicine or in-person surgical consultation group, and received professional scheduling navigation. The latter intervention was compared with a historical cohort without navigation assistance. The primary outcome was completion of outpatient surgical consultation. Secondary outcomes included receipt of treatment and operative urgency. The trial enrolled 60 participants (30 per arm). Their mean (SD) age was 48.2 (18.2) years, 50 (83.3%) were female, 2 (3.3%) were Asian, 39 (65.0%) were Black, 8 (13.3%) were Hispanic, 11 (18.3%) were White, and 41 (68.3%) had no private insurance. The historical patient cohort included 32 participants (mean [SD] age, 45.9 [3.2] years; 27 [84.4%] female; 3 [9.4%] Asian, 15 [46.9%] Black, 10 [31.3%] Hispanic, and 6 [18.8%] White; and 18 [56.3%] without private insurance). In total, 18 trial participants assigned to telemedicine (60.0%) completed surgical consultations compared with 23 trial participants assigned to in-person visits (76.7%; P = .17). For telemedicine participants who underwent cholecystectomy, 3 of 7 (42.9%) underwent emergent cholecystectomy compared with 0 of 14 (0%) participants with in-person consultations (P = .03). Of 30 trial participants who received scheduling navigation, 23 (76.7%) completed surgical consultations compared with 15 of 32 patients in the historical cohort who did not receive scheduling navigation (46.9%; P = .02). Of 14 trial participants who received scheduling navigation and cholecystectomy, no participants underwent emergent cholecystectomy compared with 4 of 16 (25.0%) participants in the historical cohort without scheduling navigation (P = .04). In this pilot randomized clinical trial of socially vulnerable adults with symptomatic cholelithiasis, telemedicine consultation compared with in-person visits did not improve access to elective outpatient surgical care. However, scheduling navigation services may improve access to elective outpatient surgical care. Future large-scale studies are needed to identify possible barriers to virtual health care and mechanisms to address inequities. ClincialTrials.gov Identifier: NCT05745077.

Evaluation of guideline recommended treatment utilization among Black and White men with metastatic prostate cancer.

103 Background: Prostate cancer is the second leading cause of cancer death among men with a disproportionate burden on Black men. 1 Black men are twice as likely to die from prostate cancer compared to White counterparts. 2 Racial disparities in care delivery for early-stage disease are well documented and may contribute to disparate outcomes, 3–6 but less is known about racial gaps in advanced prostate cancer care, a stage where effective therapies can prolong life for years. 7 We sought to evaluate if treatment disparities were evident among Black and White men with metastatic prostate cancer. Methods: We performed a retrospective cohort study of patients with metastatic prostate cancer receiving treatment at a large public tertiary care health system between 2015 and 2020. Demographic, clinical, treatment, and medication prescribing data were extracted from the electronic health record. We excluded patients without ICD codes indicating metastatic disease, those without any documented medication data in our health system, and those who did not identify as Black or White race. We estimated the prevalence ratio (PR) of being prescribed each of the recommended treatment options for metastatic prostate cancer per National Comprehensive Care Network guidelines, including androgen deprivation therapy (ADT), novel anti-androgens, chemotherapy, and bone protection comparing Black men to White men using log-binomial regression. Results: We identified 1,594 patients with metastatic prostate cancer; 485 (30%) were Black. Black patients were younger and had higher Charlson scores compared to White men. Both groups were highly insured, Medicaid was more common for Black men (7.2% vs 2.2%). Prescribing of systemic treatments was similar by race (Table). Combination ADT and novel antiandrogen prescribing was also similar by race (PR 1.04 95% CI:(0.91 - 1.17), p=0.6). About 30% of both Black and White patients interacted with our Patient Navigation team, a group of oncology nurses focused on ensuring patients receive recommended care. Conclusions: In a large public tertiary care health system, we did not observe racial disparities in receipt of guideline recommended therapies for metastatic prostate cancer. High rates of insurance, a robust patient navigation program, and a well-developed pharmacy assistance program may have helped mitigate racial disparities in care. Ongoing analyses are evaluating prescribing patterns among patients with de novo metastatic disease. Future studies should explore delivery of prostate cancer therapies across health systems and the influence of patient navigation and pharmacy assistance programs on medication receipt. Prevalence ratios of treatment by race. Medication PR (95% CI) for Black v White men p-value ADT 1.04 (0.98-1.11) 0.19 Novel Antiandrogen 1.05 (0.95-1.16) 0.31 Bone protection 0.89 (0.76-1.04) 0.13 Chemotherapy 1.09 (0.85-1.39) 0.51

Feasibility of augmented reality combine patient-specific implants (PSI) applied to navigation in mandibular genioplasty: A phantom experiment

Purpose: Genitoplasty is becoming more and more common, and it is important to improve the accuracy of the procedure and simplify the procedure. This experiment explores the feasibility of using augmented reality (AR) technology combined with PSI titanium plates for navigational assistance in genioplasty performed on models, aiming to study the precision of such surgical interventions.Methods: Twelve genioplasty procedures were designed and implemented on 3D-printed resin mandibular models by the same surgeon using three different approaches: AR+3DT group (AR+PSI) , 3DT group (patient-specific titanium plate) , and a traditional free-hand group(FH group). Postoperative models were assessed using CBCT to evaluate surgical accuracy.Results: In terms of osteotomy accuracy, the AR group demonstrated a surgical error of 0.9440±0.5441 mm, significantly lower than the control group, which had an error of 1.685±0.8907 mm (P < 0.0001). In experiments positioning the distal segment of the chin, the overall centroid shift in the AR group was 0.3661±0.1360 mm, significantly less than the 2.304±0.9629 mm in the 3DT group and 1.562±0.9799 mm in the FH group (P < 0.0001). Regarding angular error, the AR+3DT group showed 2.825±1.373°, significantly <8.283±3.640° in the 3DT group and 7.234±5.241° in the FH group.Conclusion: AR navigation technology combined with PSI titanium plates demonstrates higher surgical accuracy compared to traditional methods and shows feasibility for use. Further validation through clinical trials is necessary.

Enhancing Accessibility: A Heuristic Evaluation of Social Presence Interface Design for E-Resources in University Libraries

In this preliminary investigation, a discerning evaluation reveals that users face pervasive challenges accessing e-resources within university libraries. A social presence interface design for e-resources is introduced, recognizing the need for user support through effective communication with librarians and assistance for swift information navigation and system function. This research presents a meticulous usability assessment grounded in heuristic evaluation, engaging six expert evaluators comprising specialists in human-computer interaction and librarians. The primary objective is to ascertain the intuitiveness of the interface design and identify potential issues through expert scrutiny. The study unveiled compelling insights by employing a tailored usability heuristic questionnaire encompassing 39 questions aligned with the developed design. Notably, 75.54% of evaluators agreed unanimously regarding the design’s adherence to heuristic principles, indicating their concurrence with the established criteria. Additionally, evaluators provided valuable commentary and feedback focusing on aspects related to icons, labels, and the efficacy of the help function. This comprehensive evaluation informs and enhances the ongoing discourse surrounding optimal user interface design for e-resources in university library settings.

P226. Advanced imaging-based accuracy of pedicle screw placement using an augmented-reality assisted navigation system

P226. Advanced imaging-based accuracy of pedicle screw placement using an augmented-reality assisted navigation system

Augmented reality technology in tourism and hospitality research: a review from 2010 to 2024

Purpose Augmented reality (AR) is revolutionizing the tourism and hospitality industry by offering immersive experiences as well as creating more engaging, informative and accessible travel experiences that attract tourists from around the globe. From virtual tours and immersive historical site recreations to navigation assistance and cultural education, AR technology is transforming the way we explore and interact with the destinations. This study aims to identify benefits, risks, tools and techniques of AR in the tourism and hospitality literature. Design/methodology/approach The authors conducted a systematic literature review to answer six research questions. The authors also identified 33 primary studies, dated from January 2010 to February 2024 and coded them via a thematic analysis. Related studies were obtained through searching in Web of Science and Scopus. Findings The results identified nine themes for benefits, eight themes for risks/disadvantages and four tools and applications-related themes. Through the thematic analysis, the major benefits of AR in the tourism and hospitality were found to be differentiated travel experiences, improved performance of tourism value chain, more effective marketing efforts of tourism businesses, enhanced tourists’ engagement, enhanced performance of tourism destinations, stimulated behavioral intentions, tourist empowerment and providing more value, interactivity and integrity. Furthermore, eight risks were identified: physical, privacy and security, social, service failure, technical, psychological, managerial, information and knowledge gaps. The authors also recognized four tools and applications-related themes, namely, AR-enabled tools, AR applications, AR-enabled apps and AR-based techniques. Originality/value To the best of the authors’ knowledge, this review provides the first systematic exploration of the existing literature on usage of AR in the context of tourism and hospitality value chain.

Real-time digital twin of autonomous ships based on virtual-physical mapping model

The advancement of intelligent technology has propelled the development of smart unmanned vessels into a new phase. To address the urgent demands of current smart ship development, this paper develops a comprehensive ship digital twin system based on a virtual-real mapping algorithm, focusing on the fundamental elements of digital twin model construction. Using the smart unmanned experimental ship Dolphin 1 as a prototype, a digital twin virtual model is proposed. This system leverages real-time internal and external data from the entire vessel to track its navigational status, performance indicators, sailing trends, and surrounding flow field information, offering coordinated “human-machine” navigation assistance. Based on historical data collected from the vessel's long-term navigation, a real-time precise prediction of the vessel's navigational state and hydrodynamic performance is conducted using physics-informed neural network algorithm. This establishes a self-learning iterative virtual-physical mapping model that enables autonomous updates and evolution. As the real navigation data of the vessel continuously update, the virtual model can more accurately simulate the vessel's state in real time. The proposed digital twin model has been tested through sea trials under real sea conditions, demonstrating its high accuracy, robustness, and potential for enhancing navigational safety and efficiency. This system marks a significant step forward in the integration of digital twin technology with maritime navigation, providing a valuable tool for the future development of smart shipping.

Towards neuroadaptive navigation assistance to reduce spatial de-skilling

Maps have been invaluable navigation aids for millennia and thus have been critical for human survival. The increasing popularity of and high dependence on digital, location-aware assistive navigation technology, however, has been shown to divert our attention from the environment and to negatively influence innate spatial abilities. To mitigate this, neuroadaptive mobile geographic information displays (namGIDs) are proposed that respond in real-time to navigators’ cognitive task demands and wayfinder’s situated visuo-spatial attention needs. In doing so, namGIDs may not only help navigators maintain navigation efficiency but more importantly, also continuously scaffold spatial learning. To do this, the proposed navigation assistance must strike the appropriate balance between welcomed mobility efficiency gains while limiting human spatial deskilling. Leveraging neuroadaptive cartography, we can ensure to remain effective navigators, empowered to explore the world with confidence.

Application of Large Language Models and Assessment of Their Ship-Handling Theory Knowledge and Skills for Connected Maritime Autonomous Surface Ships

Maritime transport plays a critical role in global logistics. Compared to road transport, the pace of research and development is much slower for maritime transport. It faces many major challenges, such as busy ports, long journeys, significant accidents, and greenhouse gas emissions. The problems have been exacerbated by recent regional conflicts and increasing international shipping demands. Maritime Autonomous Surface Ships (MASSs) are widely regarded as a promising solution to addressing maritime transport problems with improved safety and efficiency. With advanced sensing and path-planning technologies, MASSs can autonomously understand environments and navigate without human intervention. However, the complex traffic and water conditions and the corner cases are large barriers in the way of MASSs being practically deployed. In this paper, to address the above issues, we investigated the application of Large Language Models (LLMs), which have demonstrated strong generalization abilities. Given the substantial computational demands of LLMs, we propose a framework for LLM-assisted navigation in connected MASSs. In this framework, LLMs are deployed onshore or in remote clouds, to facilitate navigation and provide guidance services for MASSs. Additionally, certain large oceangoing vessels can deploy LLMs locally, to obtain real-time navigation recommendations. To the best of our knowledge, this is the first attempt to apply LLMs to assist with ship navigation. Specifically, MASSs transmit assistance requests to LLMs, which then process these requests and return assistance guidance. A crucial aspect, which has not been investigated in the literature, of this safety-critical LLM-assisted guidance system is the knowledge and safety performance of the LLMs, in regard to ship handling, navigation rules, and skills. To assess LLMs’ knowledge of navigation rules and their qualifications for navigation assistance systems, we designed and conducted navigation theory tests for LLMs, which consisted of more than 1500 multiple-choice questions. These questions were similar to the official theory exams that are used to award the Officer Of the Watch (OOW) certificate based on the Standards of Training, Certification, and Watchkeeping (STCW) for Seafarers. A wide range of LLMs were tested, which included commercial ones from OpenAI and Baidu and an open-source one called ChatGLM, from Tsinghua. Our experimental results indicated that among all the tested LLMs, only GPT-4o passed the tests, with an accuracy of 86%. This suggests that, while the current LLMs possess significant potential in regard to navigation and guidance systems for connected MASSs, further improvements are needed.

Enhancing Patient Outcomes Through Integrated Education and Navigation Programs at the Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University.

Breast cancer remains a significant global health challenge, particularly in low- and middle-income countries where disparities in healthcare exacerbate the disease burden. The Breast Cancer Comprehensive Center at the National Cancer Institute, Cairo University, has implemented integrated patient navigation and education programs aimed at enhancing patient outcomes and healthcare quality.This study evaluated the effectiveness of these programs involving 2202 participants over 12 months. The methodology included systematic data collection, material preparation, and the application of tailored educational strategies to facilitate the patient's journey from diagnosis to treatment. The study utilized three-phased patient navigation assistance to provide comprehensive support.The programs significantly improved patient satisfaction, with over 90% of participants reporting high levels of contentment with the services received. Key improvements included enhanced understanding of breast cancer (including risk factors, symptoms, importance of seeking early care, and treatment options), reduction in patient anxiety, improved treatment adherence, and streamlined diagnostic and treatment processes. Notably, the use of audio-visual educational tools effectively bridged the literacy gap among patients.The integration of patient navigation and education systems at BCCC-NCI has proven to be a highly effective model for improving breast cancer care. This model not only enhances patient understanding and treatment compliance but also facilitates a more efficient healthcare process. The study underscores the potential for replicating this approach in similar healthcare settings globally, suggesting that such integrations can significantly improve cancer care outcomes.

Fewer Dislocations After Total Hip Arthroplasty With Robotic Assistance or Fluoroscopic Guidance

BackgroundComputer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance. MethodsWe reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). A DM was used in 10.4%. Fluoroscopy was used in 3,653 cases and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM. ResultsRaw dislocation rates were as follows: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated that fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); the use of navigation or DM did not demonstrate a significant reduction in risk. ConclusionsThe use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.

YOLOv3 Based Smart Assistive Navigation System for Visually Impaired Individuals

Abstract: Nowadays, some people suffer from blindness or vision impairment, either from childhood or due to other causes. These individuals frequently face difficulty to move from source to destination precisely, resulting in difficulties in their daily routines. Currently, people are using normal walking sticks, that is not useful for all the time, especially in outdoor environments, resulting in accidents and other difficulties. This paper aims to focus on improving the quality of life for blind people or visually impaired individuals by providing a suitable solution to enhance navigation and manage their needs in indoor and outdoor environments through the use of wearable devices. One proposed solution involves the method of voice assistant technology, which allows users to easily communicate and receive clear instructions. The Raspberry Pi camera module, that allows to capture images and video streaming with the Raspberry Pi, where the Ultrasonic sensor is commonly used for distance measurement to detect obstacles. Furthermore, incorporating a Neo 6m GPS module offers precise location data and navigation guidance, aiding users in reaching their destination safely and efficiently.

Exploratory in situ evaluation of the OptiBand: A haptic navigation aid for spatial perception

BACKGROUND: Vision impairments affect the ability to navigate environments and gain spatial perception of one’s surroundings. Existing navigation aids typically provide close-range information, but not feedback on farther distances (i.e., beyond 5 m from the user). OBJECTIVE: To address this gap, the OptiBand, a custom assistive device, was previously designed with a stakeholder who is blind. The OptiBand uses Lidar sensing and haptic feedback to relay information on objects up to 15 m away. In this paper, we sought to evaluate the efficacy of the OptiBand with an in situ user study. METHODS: N= 9 participants (eight blind and one low-vision) used the OptiBand for a period of three months. Users periodically rated spatial perception workload and trust of their assistive navigation aids (at first as a baseline without the OptiBand, and then with the OptiBand). RESULTS: The OptiBand tended to yield lower workload requirements and similar trust levels compared to existing navigation aids. Interview data demonstrated the usefulness of the OptiBand in selected day-to-day tasks such as navigating outdoors and maintaining appropriate interpersonal spacing. CONCLUSIONS: This work provides evidence on benefits of and potential uses of assistive navigation aids like the OptiBand. Researchers interested in similar devices can benefit from our efforts.

Inverse kinematic total knee arthroplasty using conventional instrumentation restores constitutional coronal alignment.

Restricted inverse kinematic alignment (iKA) is a contemporary alignment strategy for total knee arthroplasty (TKA), commonly performed with robotic assistance. While superior clinical results are reported for kinematic-type alignment strategies, registry data indicate no survivorship benefit for navigation or robotic assistance. This study aimed to determine the efficacy of an instrumented, restricted iKA technique for achieving patient-specific alignment. Seventy-nine patients undergoing 84 TKAs (five bilateral procedures) using an iKA technique were included for preoperative and postoperative lower limb alignment analysis. The mean age was 66.5 (range: 43-82) with 33 male and 51 female patients. Artificial intelligence was employed for radiographic measurements. Alignment profiles were classified using the Coronal Plane Alignment of the Knee (CPAK) system. Preoperative and postoperative alignment profiles were compared with subanalyses for preoperative valgus, neutral and varus profiles. The mean joint-line convergence angle (JLCA) reduced from 2.5° to -0.1° postoperatively. The mean lateral distal femoral angle (LDFA) remained unchanged postoperatively, while the mean medial proximal tibial angle (MPTA) increased by 2.5° (p = 0.001). By preservation of the LDFA and restoration of the MPTA, the mean hip knee ankle angle (HKA) moved through 3.5° varus to 1.2° valgus. The CPAK system was used to visually depict changes in alignment profiles for preoperative valgus, neutral and varus knees; with 63% of patients observing an interval change in classification. Encouraged by the latest evidence supporting both conventional instrumentation and kinematic-type TKA strategies, this study describes how a restricted, conventionally instrumented iKA technique may be utilised to restore constitutional lower limb alignment. Level III.

Assistive Systems for Visually Impaired Persons: Challenges and Opportunities for Navigation Assistance.

The inability to see makes moving around very difficult for visually impaired persons. Due to their limited movement, they also struggle to protect themselves against moving and non-moving objects. Given the substantial rise in the population of those with vision impairments in recent years, there has been an increasing amount of research devoted to the development of assistive technologies. This review paper highlights the state-of-the-art assistive technology, tools, and systems for improving the daily lives of visually impaired people. Multi-modal mobility assistance solutions are also evaluated for both indoor and outdoor environments. Lastly, an analysis of several approaches is also provided, along with recommendations for the future.

Augmented reality navigation systems in endoscopy

Navigation assistance has become part of our daily lives and its implementation in medicine has been going on for the last 3 decades. Navigation is defined as the determination of a position in space in the context of its surroundings. While routing applications used in cars highlight the street to follow, in medical applications the real-world perception of the user is enriched by digital elements that provide guidance and help the user navigate. Unlike Virtual Reality (VR) solutions, which are mainly used for training, Augmented Reality systems (AR) do not require the user to wear specific headsets/goggles, but the virtual elements are overlaid over the real image displayed on a monitor. Depending on the application and the indication, there are large differences in how much these solutions have entered clinical routine. Especially in the fields of GI endoscopy and laparoscopy, AR navigation solutions are less prominently employed in clinical practice today and still hold significant potential to elevate patient care by improved physician support. This review touches upon why AR navigation systems are currently just starting to become implemented in the GI/laparoscopic clinical routine and which applications can be expected in the GI endoscopy and laparoscopy field. By taking the practitioner’s perspective and following the intuitive navigation workflow, it gives an overview of major available and potential future AR-applications in the GI endoscopy and laparoscopy space, the respective underlying technologies, their maturity level and their potential to change clinical practice.

Robotic-Assisted Versus Navigation-Assisted Posterior Lumbar Fusion : A National Database Study.

Retrospective cohort study. The aim of this study was to compare perioperative adverse events and reoperations between navigation-assisted and robotic-assisted posterior lumbar fusion. Navigation has become increasingly utilized for posterior lumbar fusion (PLF). More recently, robotic-assisted systems have been gaining traction. However, the incremental advantage of these systems has been unclear in the literature. Patients undergoing one-level to three-level PLF (with or without anterior or posterior interbody fusion) were identified from the 2015 to 2022 M161Ortho PearlDiver Database using CPT codes. Navigation assistance was identified based on CPT coding and robotic assistance was based on ICD-10 procedural coding. Navigation-assisted cases were matched 4:1 to robotic-assisted patients based on age, sex, Elixhauser Comorbidity Index, number of levels fuse, and concomitant anterior fusion. Incidence of 90-day adverse outcomes were assessed and compared with multivariable logistical regression. Bonferroni correction was applied for multiple testing. Rate of reoperation was assessed using the Kaplan-Meier survival analysis. From 2015 to 2022, there has been a significant increase in both navigation-assisted and robotic-assisted lumbar fusions, with navigation-assisted surgery being significantly more common. After matching, there were 2401 navigation-assisted cases and 651 robotic-assisted cases. On multivariate analysis, there were no significant differences in 90-day any, severe, or minor adverse events. There was a significant increase odd of readmissions in the robotic cohort (OR: 1.77, P <0.001). There were no differences in 3-year reoperation rates between the navigation-assisted and robotic-assisted cohorts (95.8% vs. 94.0%, P =0.30). As spinal navigation has been gaining popularity and robotic assistance is starting to be further utilized, the incremental advantage of different techniques may be questioned. While further study and technique evolution are ongoing, the current study was not able to demonstrate 90-day or 3-year incremental advantages for robotics relative to navigation based on the metrics evaluated. Level III.