Can virtual simulation improve surgery skills? Yes, augmented and virtual reality help surgeons understand the 3D rendering of patients and minimize surgical risks. The augmented reality and 3D visualisation are some of the best innovations of the modern-day world. One of the best reflections of these is seen in the medical sector. Indeed, AR and 3d visualisation have accelerated the advancement of surgeries to a great extent. Augmented reality has been in existence for a few years now in training medical students dedicated to surgeries like penis implant surgery and blood clot removal. If this is your topic of interest, read on to understand the terminologies and components and comprehend some important details about this new technology overtaking the medical sector already. So, welcome to the Augmented Virtual Reality!
WHAT IS 3D AUGMENTATION REALITY?
3D Augmented Reality is a modern medical innovation for minimally invasive surgery. Augmented reality, coupled with a heads-up display aka smart glasses help the surgeons with improved accuracy and safety. Real-time surgeries can be recorded and simulated for educational purposes. AR uses AI coupled with one or more senses to perform surgical tasks more efficiently.
AR is the enhancement of real-world objects by computer-processed elements across different sensory modalities. It includes three very basic features: virtual and real-world combination, real-time sensory interaction, and 3d registration of real-world objects. AR is not a completely immersive experience like VR. While VR needs users to wear special headgear and get into a completely virtual world, AR let users continue to interact with the physical objects around them having customized digital content. It is important to note that implementation and usage of surgical navigation are still limited due to reported complexities and difficulties in integration with existing clinical practices.
Even though there are great advancements in both software and hardware, traditional modalities and economic facets play an important role in universal medical practices. With the SARS-CoV-2 (2019-nCoV) coronavirus pandemic, the adoption of augmented reality is quite relevant. Continuous enhancements are under development specific to AR imaging, e.g.: contact lenses (bionic), Virtual retinal display.
How AR and 3D Visualisation Educates Surgical Training
3D augmented and virtual reality can be used to simulate any medical situation like surgeries and help surgical students understand the underlying subject in real life. Debriefing and feedback help in learning from the mistakes. Such simulation is quite flexible as it does not require training faculty to be present. VR helps surgical professionals to visualise inaccessible interior areas of the human body. With 3d modelling, it is easy to understand the human anatomy in great detail. Surgical students can be educated using scenarios that closely imitate real-time surgery situations. Real-time surgeries are recorded from different vantage points and then students can use that model to simulate surgery in the VR. Simulation-based VR training is a very helpful and effective way of honing surgery skills. On the other side, it helps in reducing overall costs, recovery time, and postoperative complications.
How Augmented and Virtual Reality Contribute to Surgeries
Using VR, you can plan complex surgeries and simulate the scenarios and mitigate surprises. Different scans (MRI, CT, Ultrasound) are compiled and that data is used in AR/VR. For patients with post-traumatic stress disorder, medical professionals/therapists find VR very useful. It helps clients with agoraphobia or acrophobia. VR has a pivotal role to play in robotic surgeries. With the help of AR, a robotic arm surgeon remotely operates. Here the surgeon depends on the camera and some level of sensory feedback. Augmedics and Medivis have provided AR navigation solutions that augment surgeons’ vision and eventually increase precision. AR headsets collect video data and with the help of machine learning, optimal recommendations are provided during the live surgeries as well. There has been a radical improvement in the medical industry in digital imaging (MRIs, ultrasonography). With the help of AR/VR, now surgeons have access to the internals of the affected area (Knee joints, eyes, heart, etc.) before the surgery. The buzzing sound of drills and saws can be mimicked using a special glove (AR haptic gloves)
Benefits of AR and 3D visualisation in the surgical field
The use of AR in surgery has two dominant benefits for doctors. First, the education and training aspect. This allows trainees to move from the textbook dimension to real-world scenarios and visualise the health-related issues that they will be treated in the future. Secondly, AR enhances the ability to better diagnose and treat the underlying disease by having faster access to real-time data and a patient’s medical history. Even the most experienced surgeon is prone to make human error.
AR coupled with 3D visualisation mitigates human errors. Surgery procedures can be simulated multiple times with near to 100% accuracy. Since surgery using AR and 3D visualisation is done with minimum incision, it results in faster recovery and minimal or no post-operative complications. Because of the minimal incision and surgery on the affected area, the overall surgical process has become painless.
How AR is Safer for Imaging in Surgeries Compared to Traditional Methods
Diagnostic imaging has seen some of the biggest advancements in the last decade like ultrasonography, computerized tomography, mammography, magnetic resonance imaging, etc. Almost all surgeries require some or the other type of scans before incision. Even though imaging techniques have radically evolved, the imaging display remains as of the old generation. Surgeons have to give additional attention to fusing multiple images like CT and angiography into coherence to understand the patient’s condition. AR, on the other hand, superimpose digital data on physical reality. So, a surgeon executing a surgery and wearing an AR headset can visualise multiple digital images directly overlaid on the incision area. The image, data, and other vital signs of the patient’s anatomy are displayed directly overhead the surgical field. Thus, the surgeon need not get distracted from the surgical process to gather and process the information while performing critical surgeries.
The potential of augmented reality to display images and other data about the patient concurrently can save a lot of human errors and save lives by reducing medical errors. Also, the entire surgical team operating inside an OT can have access to the simultaneous display of the patient data and work incoherence, thereby avoiding any communication gap.
POPULAR SURGERIES WHERE AUGMENTED REALITY PLAYS A MAJOR ROLE
Augmented reality has cast its immense advancement on some of the prominent surgeries like spine surgery, Neuro oncological surgery, neurovascular surgery, and visceral surgery.
- Applicability of AR on Spine Surgery
Since AR is the superimposition of a virtual environment to reality, spine surgeons can benefit a lot through wearable overhead displays and image projection to the real-world surrounding. During pedicle screw fixation, Augmented reality can offer intraoperative assistance. The spine surgeon need not remove his gaze from the patient while leveraging AR during surgery. AR can also be applied to lumbar spine pedicle screw replacement. The real-time operating guidance could improve the accuracy and efficacy of spine surgeries.
- AR’s Impression in Neurosurgery
Neurosurgery is a field of medical specialty which depends heavily on imaging techniques and thus the precision of image displays is of utmost importance. The use of MRO and CT during pre-operative planning as well as intraoperative surgery is important to the success of the surgery. AR technology, at present, is commercially applicable for simulation and training in the neurology department. It has the immense potential to revolutionize the sector and take it to greater heights leading to positive patient outcomes. Neurosurgery has been successfully able to push the frontiers of AR in the operating room.
AR can precisely display several 3D datasets congruently head over the area where the neurosurgery is taking place. The advances in imaging, display technology, registration, and robotic actuation foretell an important role for augmented reality and 3D visualisation in neurosurgery. The application of 3D imaging techniques and augmented reality can boost the confidence of surgeons while performing delicate and complicated neurosurgical procedures. The tool will guide with virtual navigation while the neurosurgeons dissect and observe the anatomy of the patient. For neurosurgery training at medical universities in the future, the innovative tools of AR and VR can be infused with mixed reality.
- AR and VR in Visceral Surgery
For visceral surgery, 3D models of multiple visceral pathologies specific to a patient are segmented from the 2D magnetic resonance imaging and computed tomographic (CT). This is visualised with the aid of AR or VR which is why these two innovative tools lead to the exact surgical scheduling of complex operations.
3D Imaging and Augmented Reality in Neurovascular Surgery
For neurovascular surgery, augmented reality can be of immense use in the intraoperative brain imaging system. The use of this technology is feasible in arteriovenous malformations (AVMs), aneurysms, arteriovenous fistulae (AFVs). Using an augmented reality system, an external camera can be fitted to capture the live streaming of the patient on the operating table. These images are merged with pre-operative volume-rendered vessels. The advanced Augmented reality neuronavigation system lets patients to image registration as well as calibration of camera leading to sync AR view. AR in the neurovascular surgical field can be of importance in customizing craniotomies, planning resection corridors, and localizing vessels.
Live Instances of Augmented Reality Have Been Used in Surgeries in Living Patients
Neurosurgeons at John Hopkins have accomplished the first-ever AU surgery at the institute in living patients. The surgeons fixed 6 screws in the spine of the patient for the spinal fusion surgical process to merge 3 vertebrae. This was done to relieve the patient from chronic excruciating back pain. The next augmented reality-induced surgery, which the physicians performed where, was when they eradicated a malignant tumour, Chordoma, from the patient’s spine. According to the updates from the doctors, both the patients are doing well now and hence there goes the success of augmented reality surgeries.
The Incredible Significance of 3D Visualisation in Diagnosing ATFL (Anterior Talfibulor Ligament injury) – 3D MRI
Ligament injury is very common among sportsperson and athletes. 80%+ ankle ligament injuries are ATFL. X-ray details do not show any fractures after the sprain and there is a neglect to address the ligament injury. ATFL is positioned at an angle and is thinner compared to a normal ligament. 2-dimensional imaging (2D MRI) does not capture it since it can detect only thick slices of the ligament.
With the evolution of 3 dimensional MRI, high-resolution images can be rendered. Various spatial planes can be chosen to visualise a highly optimal display. This helps in better diagnosis and extent of the damage. Using 3D MRI medical professionals can accurately decide whether surgery is needed, or physiotherapy can help. 3D MRI is more reliable in identifying the injuries which could be partial tears or sprains. Timely diagnostic helps in deciding the line of treatment further and helps the patient recover quickly. If ligament injury becomes chronic, this can lead to structural instability. Although there is a significant difference between 2D and 3D MRI scans in diagnosing normal ligament injuries, 3D MRI is predominantly very helpful in diagnosing ATFL injuries. 3D MRI cannot be taken for all the regions due to the longer duration to scan the area and radiation exposure. Intuitively 3D reconstruction is a promising technology and can accurately display ligament damage. Doctors can simulate the process before the surgery and sequencing data of the 3D MRI helps in rendering customized anatomical models.
TOP COMPANIES USING AUGMENTED REALITY IN SURGERY:
Across the globe, scientists, data scientists, and researchers are already in the groove and determined to revolutionize the world with the advancement of AR and VR. Below are some of the top names concerning augmented reality in the surgical field.
- Fundamental VR: Founded in 2012 and located in London, United Kingdom, it was awarded in 2018 and 2019 for better innovation and interactive innovation respectively. The company offers simulators that allow users to improve their surgical skills in a controlled atmosphere. The company offers AR using MS HoloLens technology. They use near-real vibration patterns and haptic gloves give the sense of holding actual tools.
- Oxford VR: Founded in 2016 and located in Oxford, United Kingdom. It works on the research on mental health. Oxford VR won the award for best mental health immersive technology in 2020. The company is dedicated to innovating virtual reality to eradicate your problems of fear and mental ailment.
- Augmedics: Created an AR navigation system for surgery, Xvision. Using this, a surgeon can see the anatomy of the patient through skin/tissues. It acts like an X-ray vision where a surgeon can visualise the internal anatomy of the patient.
- Surgical Theater: Precision VR procedure for neurosurgery helps in preoperative planning. It has a simulation process that a patient can walk through before the surgery. It helps the patient understand the complete process in a controlled environment.
- Augmented Intelligence: They create computer-assisted augmentation tools that help medical professionals and students. It helps visualise the correct model of the human anatomy so that it’s easy to learn various aspects and improve surgical skills.
- SentiAR: The company provides a holographic AR platform for medical use. While surgeon performs a procedure, they can view a 3D image of the specific human anatomy (it hovers above the patient) in real-time. The whole process is hands-free and gives surgeons in-depth insights into a patient’s important vitals.
- Proprio: They use AR with machine learning to create 3D images that are highly precise. Surgeons can see through hindrances and work closely with peers on the surgery plans. They provide built-in AI that helps in analyzing and rendering 3D images and present surgical data in real-time during simulation or live surgeries.
A big shout out to the incredible innovation unfolded by the diligence of the team of medical researchers, scientists, mathematicians, physicists, data, science experts, and coders to unfurl augmented and virtual reality into the modern-day world. From sports, education, design training, media and entertainment, marketing, business logistics, retail, tourism, public safety in the medical field, AR is all set to take every sector by storm. It is going to revolutionize the entire medical and surgical field owing to its claimed precision. The ease and focus with which the surgeons can work in coherence with the surgical team leaving the hassles of fusing multiple patient data while operating is all due to the augmented reality and 3D visualisation.
The data synthesis method of AR lets surgeons integrate data visualisation into the diagnosis and treatment plan pre and during surgeries. This, no doubt, enhances safety and efficacy to enhance the dexterity of the surgeons. In fact, in the future, AR can completely replace a lot of items required during the surgeries used today like microscopes, displays, navigation with just a small wearable headset aided with AR. The improved accessibility to live data of the patient is gaining higher momentum in the field of surgeries. Access to live 2D or 3D reconstructed display imaged while performing surgery can be very crucial. Access to real-time data in surgeries has been possible because of the fusion of computer-generated images (CG- images) infused with real-time data tracking.
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