Safe and accurate surgery using augmented reality technology
Virtual reality is a technology that allows you to fully immerse yourself in a virtual space created by a computer using special goggles and headphones, allowing you to experience it as if it were real. It has recently been developed in the medical field as well as in areas such as medical education and surgical support. On the other hand, “augmented reality (AR)” is a technology that displays digital information overlaid on the real world. Through a smartphone screen, virtual objects created using computer graphics (CG) can be reflected on the actual scenery and displayed as if they exist in the real world. In recent years, this technology has developed in the entertainment field, such as smartphone game apps using AR.
In our orthopedic department, we perform AR microsurgery by linking the latest AR navigation to a surgical microscope, and have used it in 48 spinal and spinal cord surgeries from April 2022 to the present. This technology was developed in the field of neurosurgery in the past and has been used in spinal surgery since around 2018, but there are still only a limited number of facilities in Japan that handle AR microscopes. We started with spinal tumor surgery, but recently we have been using AR navigation in combination with microsurgery for various spinal diseases. AR microscopes use AR technology on surgical microscopes to superimpose virtual images of anatomical structures such as spinal cord, blood vessels, and bones, as well as tumors, created before surgery. First, a three-dimensional (3D) virtual image is created on a dedicated workstation from image information such as MRI and CT scans of the patient before surgery (Fig. 1).
Next, during surgery, the navigation antennas are installed on the patient side and the microscope side, and by aligning the position information, the 3D image created before surgery can be displayed inside the surgical microscope (Fig. 2).
By using AR navigation in combination, it is now possible to perform surgery more safely and accurately than ever before, making it easier to understand complex anatomical structures, performing surgery with minimal bone resection while understanding the size of the tumor, and preventing serious complications such as nerve and blood vessel damage.
Augmented reality technology for surgical education
As mentioned above, the AR microscope allows surgeons to perform surgery while displaying anatomical structures on the surface of the bone, making it extremely useful from the perspective of educating young surgeons. As surgeons learn by observing the surgical techniques of their instructors during their daily medical practice, this AR microscope surgery can be used as on-the-job training, allowing surgeons to safely perform surgical procedures such as confirming the appropriate decompression range and inserting implants while sharing the surgical field with the instructor, making it extremely useful from the perspective of surgical education (Figs. 4, 5, 6).
The figure shows an image of a cervical spine operation, showing the operation being performed while displaying bone information within the surgical field of the microscope (Fig. 3). The Tokushima University Orthopedic Surgery Department will also be working on new surgical education using AR navigation.
