Projected cutting guides using an augmented reality system to improve surgical margins in maxillectomies : A preclinical study
Copyright © 2022 Elsevier Ltd. All rights reserved..
BACKGROUND: Positive margins have been reported up to 80% in advanced maxillary cancers. Intraoperative navigation (IN) aims to improve margins, but provides a two-dimensional view of a registered instrument without anticipating any cutting directions, and the information is displayed in monitors outside surgical field. Augmented Reality (AR) can delineate margins while addressing the gaze-toggling drawback of IN. In a preclinical setting, we implemented preoperative-planned osteotomies needed for maxillectomies and projected this information on the surgical field using AR. We aimed to improve negative margin rates while retaining the benefits of AR.
METHODS: Five maxillary tumor models were built. Five fellowship-trained surgeons completed virtual unguided and AR-guided maxillectomies. Comparisons in terms of intratumoral cuts, close, adequate, and excessive distances from the tumor were performed. Differences between "ideal" cutting-plan and the AR-guided virtual osteotomies was obtained. Workload questionnaires to evaluate the technology were completed.
RESULTS: 115 virtual osteotomies were analyzed. Intra-tumoral and "close" margins were lower for the AR-assisted osteotomies (0.0% vs 1.9% p < 0.0001 and 0.8% vs 7.9% p < 0.0001). Proportion of "adequate" margins were higher in the AR simulations (25.3% vs 18.6%, p = 0.018). The AR osteotomies had high similarity with the pre-planned with interclass correlation index close to 1 in "adequate" margins 0.893 (95% CI: 0.804-0.949). Workload scores were better for AR-guided simulations for the domains of mental demand, performance, effort and frustration.
CONCLUSION: The projector-based AR method improved margin delineation, and preoperative planning was accurately translated to the simulations. Clinical translation will aim to consolidate our preclinical findings to improve outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:127 |
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| Enthalten in: |
Oral oncology - 127(2022) vom: 01. Apr., Seite 105775 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
H L Chan, Harley [VerfasserIn] |
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| Links: |
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| Themen: |
Augmented reality |
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| Anmerkungen: |
Date Completed 05.04.2022 Date Revised 01.06.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.oraloncology.2022.105775 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM337345538 |
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| 520 | |a Copyright © 2022 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Positive margins have been reported up to 80% in advanced maxillary cancers. Intraoperative navigation (IN) aims to improve margins, but provides a two-dimensional view of a registered instrument without anticipating any cutting directions, and the information is displayed in monitors outside surgical field. Augmented Reality (AR) can delineate margins while addressing the gaze-toggling drawback of IN. In a preclinical setting, we implemented preoperative-planned osteotomies needed for maxillectomies and projected this information on the surgical field using AR. We aimed to improve negative margin rates while retaining the benefits of AR | ||
| 520 | |a METHODS: Five maxillary tumor models were built. Five fellowship-trained surgeons completed virtual unguided and AR-guided maxillectomies. Comparisons in terms of intratumoral cuts, close, adequate, and excessive distances from the tumor were performed. Differences between "ideal" cutting-plan and the AR-guided virtual osteotomies was obtained. Workload questionnaires to evaluate the technology were completed | ||
| 520 | |a RESULTS: 115 virtual osteotomies were analyzed. Intra-tumoral and "close" margins were lower for the AR-assisted osteotomies (0.0% vs 1.9% p < 0.0001 and 0.8% vs 7.9% p < 0.0001). Proportion of "adequate" margins were higher in the AR simulations (25.3% vs 18.6%, p = 0.018). The AR osteotomies had high similarity with the pre-planned with interclass correlation index close to 1 in "adequate" margins 0.893 (95% CI: 0.804-0.949). Workload scores were better for AR-guided simulations for the domains of mental demand, performance, effort and frustration | ||
| 520 | |a CONCLUSION: The projector-based AR method improved margin delineation, and preoperative planning was accurately translated to the simulations. Clinical translation will aim to consolidate our preclinical findings to improve outcomes | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Augmented reality | |
| 650 | 4 | |a Maxillectomies | |
| 650 | 4 | |a Surgical margins | |
| 650 | 4 | |a Surgical navigation | |
| 700 | 1 | |a Sahovaler, Axel |e verfasserin |4 aut | |
| 700 | 1 | |a Daly, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Ferrari, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Franz, Leonardo |e verfasserin |4 aut | |
| 700 | 1 | |a Gualtieri, Tommaso |e verfasserin |4 aut | |
| 700 | 1 | |a Tzelnick, Sharon |e verfasserin |4 aut | |
| 700 | 1 | |a Eu, Donovan |e verfasserin |4 aut | |
| 700 | 1 | |a Manojlovic-Kolarski, Mirko |e verfasserin |4 aut | |
| 700 | 1 | |a Berania, Ilyes |e verfasserin |4 aut | |
| 700 | 1 | |a Orzell, Susannah |e verfasserin |4 aut | |
| 700 | 1 | |a de Almeida, John R |e verfasserin |4 aut | |
| 700 | 1 | |a Goldstein, David P |e verfasserin |4 aut | |
| 700 | 1 | |a Nicolai, Piero |e verfasserin |4 aut | |
| 700 | 1 | |a Gilbert, Ralph W |e verfasserin |4 aut | |
| 700 | 1 | |a Irish, Jonathan C |e verfasserin |4 aut | |
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