Surgical Navigation Research Articles

BN SO01 - Fluorescent Precision: Advancing Laparoscopic Cholecystectomy with Indocyanine Green ( ICG )

Abstract Background Laparoscopic cholecystectomy represents a significant advancement in surgical techniques for gallbladder disease. However, challenges persist in accurately identifying critical structures such as the bile ducts, leading to complications. Indocyanine Green (ICG), a fluorescent dye with unique properties, has emerged as a promising tool to enhance precision and safety in laparoscopic cholecystectomy. Originally developed for infrared photography, ICG's fluorescence capabilities have been harnessed in various medical applications, including ophthalmology and surgical procedures. Its ability to provide real-time visualization of the biliary anatomy facilitates better surgical navigation, reducing the risk of inadvertent injury and improving overall outcomes. Method Comprehensive review of existing literature and research on laparoscopic cholecystectomy, with a focus on the role of Indocyanine Green (ICG) in enhancing surgical precision and safety. Relevant articles, clinical trials, and meta-analyses were identified through databases such as PubMed, Google Scholar, and Scopus. Search terms included "laparoscopic cholecystectomy," "Indocyanine Green," "fluorescence imaging," and related terms. Results The results of this study highlight the significant role of Indocyanine Green (ICG) in laparoscopic cholecystectomy. Through a comprehensive review of existing literature and research, it was found that ICG integration enhances surgical precision and safety by providing real-time visualization of the biliary anatomy. The use of ICG reduces the risk of inadvertent injury and improves overall surgical outcomes. Despite challenges such as technical complexities and safety considerations, the evidence strongly supports the transformative potential of ICG in modern surgery. Conclusion In conclusion, the integration of Indocyanine Green (ICG) into laparoscopic cholecystectomy represents a pivotal advancement in surgical practice. The findings of this study underscore the importance of cautious navigation and collaboration in maximizing the benefits of ICG. By addressing challenges through innovation and evidence-based guidelines, ICG has the potential to revolutionize the landscape of minimally invasive surgery, offering patients safer procedures and better outcomes. As research continues to evolve, the journey of ICG in laparoscopic cholecystectomy holds promise for a future where precision and safety converge, ultimately shaping the standard of surgical excellence.

Semantic Segmentation Based on Geometric Calibration Using AI and AR in Health Care

In the medical field, medical imaging is essential for precise diagnosis, treatment planning, and condition monitoring. The goal of this work is to improve the field of healthcare imaging by investigating the complementary applications of augmented reality (AR) and artificial intelligence (AI) in semantic segmentation. More precise identification and delineation of anatomical structures and abnormalities in medical images is made possible by AI-driven semantic segmentation, opening the door to more precise diagnosis and treatment plans. Modern AI algorithms are employed in the suggested methodology to perform semantic segmentation in a variety of medical imaging modalities, including ultrasound, CT, and MRI scans. The detection of anomalies such as tumours, irregularities in organs, and neurological disorders is made easier by these algorithms. The foundation for integrating augmented reality technologies into the healthcare ecosystem is provided by the segmented medical images. AR enhances the interaction and visualization of segmented medical data in the context of healthcare. Real-time augmented reality overlays help surgeons by improving surgical navigation and precision. Additionally, AR apps help with medical education by offering professionals and students alike an immersive learning environment. AR provides interactive visualizations to help patients understand their medical conditions when they are going for therapy and rehabilitation. The difficulties in integrating these technologies in the healthcare industry are discussed in this paper, with a focus on the significance of data privacy, regulatory compliance, and easy integration with current healthcare systems. The successful deployment of AI technologies necessitates interdisciplinary collaboration among AI developers, healthcare professionals, and AR specialists to ensure compliance with ethical, legal, and clinical standards mandated in the healthcare domain. The proposed Segmentation mask is redefined with geometric calibration and used with U-Net for image segmentation. The segmentation is experimented on Cityscapes and PASCAL VOC 2012 datasets. The experimental results show that proposed semantic segmentation based on geometric calibration yields more accuracy than its counterparts.

SURG-26. IMPROVEMENT IN PRECISION AND SURGICAL EFFICIENCY USING THE STEALTH AUTOGUIDE™

Abstract INTRODUCTION The Stealth Autoguide™ (Medtronic) automatically determines the path for guiding instruments based on the created surgical plan. It seamlessly integrates continuous real-time navigation with robotic alignment capabilities, enhancing intraoperative workflow efficiency and supporting precise positioning. Our institution has achieved favorable results with surgeries utilizing the Stealth Autoguide™, and we report these outcomes and our future prospects. METHODS We conducted 15 surgeries at our institution using the StealthStation S8 (Medtronic) linked with the Stealth Autoguide™. The average age was 56.2 years, with 10 males and 5 females, all under general anesthesia. RESULTS The cases included 11 gliomas, 2 primary central nervous system lymphomas, 1 germ cell tumor, and 1 brain abscess. Applications of the Stealth Autoguide™ included 7 biopsies (6 burr holes, 1 craniotomy), 6 placements of fenestrations, and 2 tubing placements. The biopsies allowed for quick and reliable tissue sampling. In fenestration cases, it was possible to position quickly and precisely at the target, placing it at the planned site with high accuracy. Additionally, by using a 3D endoscopic system, surgeons could view both the surgical field and navigation screens simultaneously without shifting their gaze, enhancing safety during procedures. In the case of an intraventricular germ cell tumor, tubing preceded by ViewSite™ allowed for a safe and clear surgical field. CONCLUSION Surgeries using the Stealth Autoguide™ were conducted safely and efficiently, regardless of the surgical technique, achieving high-precision positioning. Continuing to utilize this system is expected to improve the accuracy, safety, and reproducibility of surgeries, thereby reducing the burden on patients.

SURG-23. ESTABLISHMENT OF AN APPROPRIATE GLIOMA SURGERY SYSTEM CONSIDERING MOLECULAR AND FUNCTIONAL BOUNDARIES

Abstract Gliomas are invasive tumors and cannot be cured by surgery. But surgical removal has also been proven to affect treatment outcomes. Recent advances in molecular diagnostics have identified IDH mutations, especially in lower grade gliomas, allowing the identification of so-called molecular boundaries. It is conceivable that expanded resection to the molecular border may improve treatment outcome. On the other hand, extended resection may be incompatible with functional preservation. In such cases, it is also important to consider that the impact of surgery on treatment outcome has also been proven to vary by glioma genotype. While total resection has a significant prognostic impact on survival in astrocytomas with IDH mutations, the impact on survival in oligodendrogliomas that are sensitive to chemoradiotherapy and, conversely, in high-grade tumors without IDH mutations is lower than in the former. Therefore, it is important to determine the extent of removal after considering the tumor type. In general, various surgical support devices such as surgical navigation systems, fluorescent diagnosis using 5ALA, intraoperative electrophysiological monitoring, awake functional brain mapping, and intraoperative MRI are applied during glioma surgery. In addition to these, we have developed a surgical system that also focuses on tumor subtypes by introducing preoperative tumor type prediction using AI imaging and intraoperative rapid genetic diagnosis. We have further developed intraoperative rapid genetic diagnosis to identify genetic mutations around the tumor, enabling the detection of molecular boundaries. It is now possible to remove as much as possible, considering the molecular boundary, while paying sufficient attention to preservation of brain functions. Gliomas are intractable diseases, but their treatment outcomes have steadily improved over time. We are now in an era of a tailor-made surgery based on a variety of data. Implementing “appropriate surgical procedures” we aim at further improvement of treatment outcomes.

ADVANCES IN ORTHOPEDIC SURGERY

Orthopaedic surgery has undergone significant evolution with the development of minimally invasive techniques (MIT) for the treatment of complex lower limb fractures. These innovations have transformed orthopaedic management, offering less traumatic and more effective alternatives to traditional procedures. IMTs are designed to reduce tissue damage, speed up recovery and minimize post-operative complications, making them increasingly relevant in today’s orthopaedic scenario. The aim of this study is to discuss recent advances in minimally invasive techniques in orthopaedic surgery for complex lower limb fractures. The research explores the benefits of these techniques, the challenges faced in clinical practice and the future prospects for their widespread adoption. The research was based on a literature review, with a qualitative approach, using the PubMed, Google Scholar, and Scielo databases. For a comprehensive and relevant analysis of the advances and challenges of minimally invasive techniques in orthopaedic surgery, specific descriptors reflecting the area of study were applied, with a time frame covering publications from 2018 to 2023. The analysis is based on a review of up-to-date literature, including clinical studies and meta-analyses that demonstrate the efficacy and safety of minimally invasive techniques. Innovations such as the use of external fixators, locked intramedullary rods and surgical navigation systems are highlighted. These approaches allow for precise stabilization of fractures with smaller incisions and less impairment of soft tissue vascularization. In addition, advances in intraoperative imaging and surgical instrumentation are discussed, which have improved the precision of procedures and reduced operative time. Challenges such as the learning curve and the cost of the technologies are also addressed. Thus, advances in minimally invasive techniques have revolutionized orthopaedic surgery, offering effective solutions for the treatment of complex lower limb fractures. Despite the challenges, such as the need for specialized training and investment in new technologies, the benefits for patients, including shorter recovery times and better functional results, are undeniable. The future of orthopaedic surgery will continue to benefit from these innovations, with the potential to further increase access and the quality of treatments.

Dynamic Calibration and Multi-View Fusion of Active Vision Tracking System for Surgical Instrument

Abstract In recent years, surgical instrument tracking has gained significant attention in the field of surgical navigation. An often-overlooked problem lies in the instrument’s irregular movement conflicting with the tracking system’s fixed viewpoint, leading to line-of-sight (LOS) occlusion, marker occlusion, and sub-optimal accuracy. The active vision tracking system (which actively adjusts the camera viewpoint) is applied to address this issue. In this paper, two algorithms of multi-view fusion and dynamic calibration are proposed in multi-camera active vision to allow each camera to adjust its viewpoint independently. These algorithms are integrated into the parallel computing of the frontend and backend to implement the positioning of the instrument from multiple perspectives and real-time calibration of multiple cameras. Simulations and experiments are carried out to test the accuracy and robustness of the proposed tracking system. Results reveal that our system achieves a closer trajectory (0.12 mm) to the ground truth compared to a stereo camera tracking system (0.32 mm). The proposed tracking system is able to keep track of the instruments within the positioning volume at different surgical phases, ensuring consistent navigation and improving positioning stability and accuracy.

A novel friction coefficient model parameters identification method for needle-tissue insertion procedure

Abstract In endoscopic liver vascular insertion surgeries, during the process of angiographic operation, the success of vascular staining depends on precise needle insertion control which heavily relies on experienced surgeons. Endoscopic vascular insertion surgical navigation system shows the potential to improve position precision, however it relies on needle-tissue interaction model and parameter identification to provide essential information for improving needle insertion accuracy, in which the friction coefficient is important parameters but difficult to determine. In this paper, a novel needle-tissue friction coefficient identification method was proposed with unknown tissue Young's modulus under endoscopic liver surgery scenarios. A modified friction coefficient model was proposed including the adhesion and elastic friction component to describe needle-tissue dynamic interaction process which can predict the friction coefficient more precisely. The proposed parameter estimation method based on the modified friction model can simultaneously estimate friction coefficient and Young's modulus. The proposed method was demonstrated by the friction coefficient measurement experiment. The results showed that the friction coefficient model prediction results agreed well with expected value. The proposed method can be applied to provide essential tissue-needle interactive information to improve needle insertion precision in the endoscopic liver vascular insertion surgery scenarios.

Evaluating the References of Insurance Policies for Computer-Assisted Navigation in Total Knee Arthroplasty Compared With the American Academy of Orthopaedic Surgeons Clinical Practice Guideline.

This study aimed to investigate the quality and quantity of sources cited by insurance payers for computer-assisted navigation (CAN) in total knee arthroplasty (TKA) and to compare these sources with those cited by the American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guideline (CPG). References were included from insurance payer policies on CAN that discussed the use of CAN in TKA, while every reference from the AAOS CPG for surgical navigation in TKA was included. Fifty-four unique articles from insurance payers met criteria, with 68.5% being primary journal articles and 18.5% being reviews. The quality of cited studies was relatively evenly distributed between level of evidence (LOE) I/II (42.6%) and LOE III and below (50.0%). The 14 references cited in the AAOS CPG were 100% primary articles and 100% LOE I/II. Only 16.3% of cited insurance references were AAOS CPG articles. Nine of the 14 AAOS CPG studies were not cited by any of the insurance payer policies. Compared with the AAOS CPG, insurance policies cited older articles with lower LOE. We recommend continued updating of the AAOS CPG and insurance policies as more research into the use of CAN in TKA is published. [Orthopedics. 202x;4x(x):xx-xx.].

Precision and effort in robot-assisted placement of pedicle screws compared to standard surgical navigation.

Aim was to compare image-guided navigation with a robot-assisted solution for performing MISS regarding precision, required time and subjective aspects. 90 pedicles were instrumented on two torsos, half with navigation, half robot-assisted. Precision analysis between both solutions didn't show a significant difference. Time measurement showed a significantly longer duration per wire for the robot-arm on the first torso and a not significant longer duration on the second torso, where a significant reduction in the mean duration was shown. There was no significant difference in the subjective impressions comparing navigation and robot except the possibility to change the procedure. Precision of both methods is suitable for clinical use. A time advantage using the robot-arm couldn't be demonstrated in the present study. A significant learning curve was shown, so a reduction in the longer duration on the robot can be expected. Further studies in clinical use are necessary.

Electrostatic Assembly of Gold Nanoclusters in Reverse Emulsion Enabling Nanoassemblies with Tunable Structure and Size for Enhanced NIR-II Fluorescence Imaging.

The precise control of the assembly structure and size of gold nanoclusters (AuNCs) can potentially amplify their near-infrared II (NIR-II) fluorescence imaging and targeting properties. However, the conventional electrostatic assembly of AuNCs and charged molecules faces challenges in balancing the inherent electrostatic repulsions among charged units and regulating the diffusion of assembly units. These difficulties limit precise control over assembly size and structure, along with limited options for coassembled molecules, thereby restricting imaging properties and targeting capability. To circumvent this challenge, we developed a reverse emulsion-confined electrostatic assembly method. This technique efficiently constructs AuNC nanoassemblies with diverse coassembled molecules, allowing for the fine-tuning of assembly size and structure, including both core-satellite and homogeneous AuNC nanoassemblies. The development of two distinct nanoassemblies can be partially attributed to the varying diffusive rates of AuNCs or the AuNCs/polymer complex within the fused emulsion droplets. This variance arises from steric hindrances encountered during the emulsion fusion process. Interestingly, core-satellite nanoassemblies exhibit the strongest NIR-II fluorescence enhancement. Finally, the introduction of a hyaluronic acid coating on the surfaces of nanoassemblies with varying sizes enables the nanoprobes to achieve enhanced lymph node imaging through size modulation and macrophage targeting, which are used for surgical navigation to remove lymph node metastases. We envision that this self-assembly strategy can be extended to a wide range of electrostatic assembly systems for the development of multicomponent functional materials.

A universal calibration framework for mixed-reality assisted surgery

Background:Mixed-reality-assisted surgery has become increasingly prominent, offering real-time 3D visualization of target anatomy such as tumors. These systems facilitate translating preoperative 3D surgical plans to the patient’s body intraoperatively and allow for interactive modifications based on the patient’s real-time conditions. However, achieving sub-millimetre accuracy in mixed-reality (MR) visualization and interaction is crucial to mitigate device-related risks and enhance surgical precision. Objective:Given the critical role of camera calibration in hologram-to-patient anatomy registration, this study aims to develop a new device-agnostic and robust calibration method capable of achieving sub-millimetre accuracy, addressing the prevalent uncertainties associated with MR camera-to-world calibration. Methods:We utilized the precision of surgical navigation systems (NAV) to address the hand-eye calibration problem, thereby localizing the MR camera within a navigated surgical scene. The proposed calibration method was integrated into a representative surgery system and subjected to rigorous testing across various 2D and 3D camera trajectories that simulate surgeon head movements. Results:The calibration method demonstrated positional errors as low as 0.2 mm in spatial trajectories, with a standard error also at 0.2 mm, underscoring its robustness against camera motion. This accuracy complies with the accuracy and stability requirements essential for surgical applications. Conclusion:The proposed fiducial-based hand-eye calibration method effectively incorporates the accuracy and reliability of surgical navigation systems into MR camera systems used in intraoperative applications. This integration facilitates high precision in surgical navigation, proving critical for enhancing surgical outcomes in mixed-reality-assisted procedures.

Mixed reality combined with surgical navigation technology assisted in parapharyngeal space tumors surgery: a clinical study

Objective: To assess the feasibility and application of mixed reality combined with surgical navigation technology in parapharyngeal space tumor surgery, and to provide a reference for the development and promotion of this technology. Methods: In this study, retrospective data collection was conducted on 16 patients with parapharyngeal space tumors who were treated at the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2020 to June 2023. The patient's age was (39.6±17.8) years, with 4 males and 12 females. Mixed reality combined with surgical navigation technology was utilized to assist physicians in the treatment of these patients. Mixed reality combined with surgical navigation technology was used to assist physicians in treatment of these patients. The application steps included acquisition of image data, processing of image data [three-dimensional (3D) reconstruction, image fusion, and virtual surgical design], development of surgical navigation plan, connection of mixed reality and navigation system, automatic registration and intraoperative guidance and validation. In the preoperative plan, landmark points were placed on the virtual tumor and surrounding important structures reconstructed using digital software, serving to guide the localization of crucial anatomical structures. Intraoperative positioning deviation, surgical time, intraoperative blood loss, and postoperative complications were recorded and analyzed to evaluate the clinical application effectiveness of mixed reality combined with surgical navigation technology. Results: With the assistance of mixed reality combined with surgical navigation technology, 16 patients successfully underwent tumor resection. All patients were accurately diagnosed preoperatively by 3D reconstruction and image fusion technology, and a comprehensive preoperative plan was formulated; intraoperatively, mixed reality combined with surgical navigation technology was utilized for the localization of important structures. The average localization deviation of 38 landmark points during the operation were (4.43±1.96) mm, with 62% (26/42) of the points having a deviation of ≥0 and<5 mm. The average duration of the operation was (149.6±53.9) min and the blood loss was 70 (45, 150) ml. The average postoperative follow-up was 16 months, and five patients experienced postoperative complications involving facial paralysis, hoarseness, and choking. Conclusions: Mixed reality combined with surgical navigation technology can achieve the three-dimensional visualization of oral and maxillofacial anatomical structures to achieve precise preoperative diagnosis. During surgery, the technology can real-time display the relationship between soft tissue tumors and the surrounding important anatomical structures, guide surgical operation, and enhance the safety of surgery.

3D Multiview Holographic Display with Wide Field of View Based on Metasurface

Abstract3D display technology offers a more realistic visual experience by allowing users to perceive depth and spatial awareness, enhancing interactivity and immersion. Among various approaches, multiview display technology constructs 3D images by offering multiple smooth views along the horizontal plane. Metasurfaces, with ultra‐thin physical structures and flexible functional designs, are positioned to make significant contributions to the evolution of 3D display technologies. Here, a 3D multiview holographic display system based on metasurfaces is proposed. Using generalized Snell's law, a spatially multiplexed metasurface is designed with nine views and achieves 3D display by cascading the metasurface with a spatial light modulator (SLM). By projecting holograms onto different areas of the metasurface via the SLM, corresponding reconstructed images can be observed from specific designed directions. Thanks to the large numerical aperture (NA) of the metasurface, the system successfully achieves nine views within a 120° field of view (FOV, with a theoretical maximum of 180°), validated experimentally. This system promises potential applications in VR/AR display, surgical navigation, geographic information system (GIS), and other fields.

Influence of the Vertek aiming device on the surgical accuracy of computer-assisted drilling of the equine distal sesamoid bone-An experimental cadaveric study.

To determine the effect of the Vertek aiming device (VAD) on the surgical accuracy of navigated drilling of the distal sesamoid bone (DSB). Experimental cadaveric study. A total of 30 paired equine cadaveric limbs from 15 horses. Each specimen was placed in a purpose-built frame (PBF). Preoperative cone beam computed tomography (CBCT) images were acquired with an imaging unit coupled with a surgical navigation system. In the DSB of each specimen, a 4.5 mm glide hole and a 3.2 mm thread hole were drilled under navigation guidance, to simulate drilling for the repair of a mid-sagittal DSB fracture. In the VAD group navigated drilling was assisted by using the VAD. In the free-hand drilling group navigated drilling was performed without the VAD. Pre-and postoperative CBCT scans were merged and surgical accuracy aberrations (SAA) between the planned drill corridor and the created bone tunnel were measured. Descriptive statistics and repeated-measures analyses of variance (rep.-meas. ANOVA) were performed to compare SAA measurements between the study groups. The SAA measurements ranged from 0 to 2.9 mm in the free-hand group and from 0 to 2.8 mm in the VAD group. The median overall SAA was lower in the VAD group than in the free-hand navigated group (0.6 mm ± [0.5-0.7] vs. 0.8 mm ± [0.7-1], rep.-meas. ANOVA p = .007). The additional use of the VAD in the described set-up for navigated drilling significantly improved surgical accuracy. The combined use of the VAD and PBF may help improve surgical accuracy in navigated lag screw repair of DSB fractures.

Target-specified reference-based deep learning network for joint image deblurring and resolution enhancement in surgical zoom lens camera calibration

Background and objectiveFor the augmented reality of surgical navigation, which overlays a 3D model of the surgical target on an image, accurate camera calibration is imperative. However, when the checkerboard images for calibration are captured using a surgical microscope having high magnification, blur owing to the narrow depth of focus and blocking artifacts caused by limited resolution around the fine edges occur. These artifacts strongly affect the localization of corner points of the checkerboard in these images, resulting in inaccurate calibration, which leads to a large displacement in augmented reality. To solve this problem, in this study, we proposed a novel target-specific deep learning network that simultaneously enhances both the blur and spatial resolution of an image for surgical zoom lens camera calibration. MethodsAs a scheme of an end-to-end convolutional deep neural network, the proposed network is specifically intended for the checkerboard image enhancement used in camera calibration. Through the symmetric architecture of the network, which consists of encoding and decoding layers, the distinctive spatial features of the encoding layers are transferred and merged with the output of the decoding layers. Additionally, by integrating a multi-frame framework including subpixel motion estimation and ideal reference image with the symmetric architecture, joint image deblurring and enhanced resolution were efficiently achieved. ResultsFrom experimental comparisons, we verified the capability of the proposed method to improve the subjective and objective performances of surgical microscope calibration. Furthermore, we confirmed that the augmented reality overlap ratio, which quantitatively indicates augmented reality accuracy, from calibration with the enhanced image of the proposed method is higher than that of the previous methods. ConclusionsThese findings suggest that the proposed network provides sharp high-resolution images from blurry low-resolution inputs. Furthermore, we demonstrate superior performance in camera calibration by using surgical microscopic images, thus showing its potential applications in the field of practical surgical navigation.

Application value of surgical navigation system based on deep learning and mixed reality for guiding puncture in percutaneous nephrolithotomy: a retrospective study.

This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p < 0.05). The application of navigation system based on deep learning and mixed reality in PNL for kidney stones allows for real-time intraoperative navigation, with acceptable accuracy and safety. Most importantly, this technique is easily mastered, particularly by novice surgeons in the field of PNL.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Multivalent supramolecular fluorescent probes for accurate disease imaging.

Optical imaging is a powerful tool for early disease detection and effective treatment planning, but its accuracy is often compromised by the uptake of imaging materials by the mononuclear phagocyte system (MPS). Herein, we leverage multivalent host-guest interactions between cyanine dyes and β-cyclodextrin polymers to develop supramolecular probes with enhanced stability, optical, and transport profiles for accurate in vivo imaging. These multivalent interactions not only ensure the stability of the probes but also enhance fluorescence efficiency by minimizing nonradiative decay. Our self-assembly approach effectively modulates probe size and surface properties, enabling evasion of MPS clearance and promoting prolonged bloodstream circulation, thereby improving the signal-to-background ratio for imaging. The effectiveness of our design is demonstrated by substantial advancements in the early diagnosis of acute kidney injury and by providing high-contrast imaging and precise surgical navigation across various tumor models. Our strategy not only advances optical imaging materials toward clinical translation but also establishes a versatile platform applicable to multiple imaging modalities.

Semi-Automated Virtual Endoscopy of the Frontal Recess.

Virtual endoscopy (VE) is the computer-based reprocessing of diagnostic imaging to simulate endoscopy of an anatomic region of interest. VE of the Frontal Sinus Outflow Tract (FSOT) may assist surgical planning and education. VE was performed on 16 normal sinus computed tomography (CT) scans for a total of 32 sides using the "path-to-target" tool on the TruDi surgical navigation system (ver. 2.3; Acclarent, Irving, CA, USA). To aid orientation during VE, planning points were placed on the middle turbinate, ethmoidal bulla, and skull base. The VE representation of anatomy and FSOT accuracy was manually confirmed by reviewing the corresponding orthogonal CT images and comparing them to the computed pathway. Of the 32 sides, the software successfully calculated the FSOT in 22 sides (69%). Of those 22 sides, the calculated FSOT, depicted in the VE sequences accurately represented the FSOT. Among sides with an accurately calculated FSOT, the VE sequences depicted a "fly-through" from a starting point in the middle meatus around various frontal recess cells to the end point in the frontal sinus. This pilot study demonstrates that software-generated VE of the FSOT is indeed feasible but requires confirmation by the surgeon for accuracy. Instances in which the software did not achieve its objective may drive further refinements of the protocol. VE of the FSOT should be explored as a tool for preoperative planning and surgical education.

Artificial Intelligence in Oral and Maxillofacial Surgery: Bridging the Gap between Technology and Clinical Practice a Narrative Review

Objective: To provide a comprehensive overview of current applications and future prospects of artificial intelligence (AI) in oral and maxillofacial surgery (OMFS), while critically analyzing implementation challenges and exploring potential advancements.  Methods A systematic literature review was conducted using PubMed/MEDLINE and Embase databases, encompassing English-language articles up to December 30, 2023. Search terms combined OMFS and AI concepts, with database-specific syntax employed.  Results AI applications in OMFS span multiple domains, including image analysis, surgical planning, intraoperative guidance, and clinical decision support. Deep learning models have demonstrated high accuracy in detecting mandibular fractures, performing cephalometric analyses, and classifying maxillofacial pathologies. AI-enhanced surgical planning and robotic systems show promise in improving precision and outcomes across various OMFS procedures. However, challenges persist in data quality, clinical validation, and seamless workflow integration.  Conclusions AI technologies have the potential to significantly enhance diagnostic accuracy, surgical precision, and treatment outcomes in OMFS. Future research directions include developing multimodal AI systems, advancing AI-powered surgical navigation, and exploring federated learning approaches. Successful implementation of AI in OMFS practice will require collaborative efforts among clinicians, researchers, engineers, and policymakers to address technical, ethical, and regulatory challenges. As these hurdles are overcome, AI is poised to become an integral part of OMFS, augmenting surgical capabilities and elevating patient care standards.