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. 2016 May;6(5):523-8.
doi: 10.1002/alr.21702. Epub 2015 Dec 31.

Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study

Martin J Citardi  1 , Abib Agbetoba  1 , Jo-Lawrence Bigcas  1 , Amber Luong  1
Affiliations

Augmented reality for endoscopic sinus surgery with surgical navigation: a cadaver study

Martin J Citardi et al. Int Forum Allergy Rhinol. 2016 May.

Abstract

Background: Augmented reality (AR) fuses computer-generated images of preoperative imaging data with real-time views of the surgical field. Scopis Hybrid Navigation (Scopis GmbH, Berlin, Germany) is a surgical navigation system with AR capabilities for endoscopic sinus surgery (ESS).

Methods: Predissection planning was performed with Scopis Hybrid Navigation software followed by ESS dissection on 2 human specimens using conventional ESS instruments.

Results: Predissection planning included creating models of relevant frontal recess structures and the frontal sinus outflow pathway on orthogonal computed tomography (CT) images. Positions of the optic nerve and internal carotid artery were marked on the CT images. Models and annotations were displayed as an overlay on the endoscopic images during the dissection, which was performed with electromagnetic surgical navigation. The accuracy of the AR images relative to underlying anatomy was better than 1.5 mm. The software's trajectory targeting tool was used to guide instrument placement along the frontal sinus outflow pathway. AR imaging of the optic nerve and internal carotid artery served to mark the positions of these structures during the dissection.

Conclusion: Surgical navigation with AR was easily deployed in this cadaveric model of ESS. This technology builds upon the positive impact of surgical navigation during ESS, particularly during frontal recess surgery. Instrument tracking with this technology facilitates identifying and cannulation of the frontal sinus outflow pathway without dissection of the frontal recess anatomy. AR can also highlight "anti-targets" (ie, structures to be avoided), such as the optic nerve and internal carotid artery, and thus reduce surgical complications and morbidity.

Keywords: augmented reality; cadaveric model; computer-aided surgery; endoscopic sinus surgery; image-guided surgery; visualization technology.

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Figures

Figure 1
Figure 1
Frontal recess cells (AN, agger nasi cell; FC1, type 1 frontal sinus; SBC, suprabullar cell) are projected upon this partially dissected left frontal recess, as viewed with a 45 degree telescope. The position of the instrument tip is displayed on the orthogonal CT images on the left.
Figure 2
Figure 2
Frontal recess cells (agger nasi cell, in orange; type 1 frontal cell in green) is projected upon a partially dissected left frontal recess, as viewed with 30 degree scope. The tip of a Ventera-R balloon catheter (Smith & Nephew/ENTrigue Surgical, Austin, TX) is displayed on the orthogonal CT images on the left.
Figure 3
Figure 3
The frontal sinus ouflow tract is projected upon the endoscopic image of the left agger nasi region. The rings change appearance as the surgeon approaches and then passes through each ring.
Figure 4
Figure 4
These rings highlight the path to the right sphenoid sinus.
Figure 5
Figure 5
The optic nerve is projected as yellow structure oriented obliquely in the center of this image of the right ethmoid cavity, which has been partially dissected. This projection allows the surgeon to know the position of this critical structure before it comes into direct view.
See this image and copyright information in PMC

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