Table 2 AR in surgery

Image-guided navigation through an AR system

Oral and maxillofacial surgery

Different types of projection-based systems, such as SMN, and screen-based systems (VectorVision) were discussed.

Two operational cases where AR has been successfully used were discussed.

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3D stereoscopic

visualization using an AR system

Oral Surgery

A 3D integral video (IV) display system and an IV AR System.

An 80-fps IV image was rendered with minimal error. Screw fixation was also effectively performed using the AR system

[70]

An intraoperative brain imaging system used for neurovascular surgery as shown in Fig. 6.

Neurovascular surgery, specifically, aneurysm surgery, arteriovenous malformation, arteriovenous fistulas

A workstation, an optical tracking system such as IGS and camera

Patient-to-image registration error was approximately 3.44 mm; calibration and rejection error was 2.02 mm. Overall AR misalignment was found to be 1–2 mm.

[71]

Computer-aided hepatic surgery planned using AR. This is performed on the liver as shown in Fig. 7.

Liver surgery and operation of liver tumors

Stereoscopic see- through HMDs, tracking systems, a rendering and tracking workstation

A table providing the interactive volumetric measurements of the liver vessels and tumor was generated. The outlined AR tool can be considered an excellent tool for surgery planning.

[72]

AR use for navigation in computer-assisted arthroscopic surgery

Post-surgical recovery of the knee

Consists of two operating modules. The first module consists of preoperative image processing, and the second is used intraoperatively.

The system was tested using an artificial model of a human knee. The virtual model obtained following segmentation using Module 1 and 3D reconstruction using Module 2 had minimal errors. Although further testing is required to validate the system, the first trials yielded positive feedback.

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Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Performance of surgical management of disease in the abdomen

The image registration technique was used along with NOTES. Through this, we could guide and position the probe in the desired orientation.

A series of experiments reveal that the display of a spatially matched reformatted reference image and the presentation of probe position in the 3D models provide valuable support to the operator in the navigation and positioning of the probes.

[74]

VR and AR in digestive surgery

Detection of parenchyma and tumors, digestive surgery

A multimedia computer was used to model a surgical planning system in 3D. CT scan and MRI scan data were run on the system, and the outputs were modified.

The overall accuracy of the system was found to be less than 5 mm. Hence, the results of the experiment clearly showed important targeting accuracy. The use of the system required an average time of 30 s, compared to the clinical procedure, which takes 5–10 min. Hence, a fully efficient and accurate image-guided surgical tool was obtained.

[75]

Assessments and considerations of the use of AR in cerebral surgery

Cerebral arteriovenous malformations (AVM) surgery and performance of AVM resections

Angio-CT and angio-MRI were implemented over an AR Iplan platform that uses BrainLAB

The following system was operated in five cases where different resections were required. Postoperative and preoperative ranking orders were generated as well. All the resections were successful, except in the case of one patient who was pregnant during her AVM operation.

[76]