AR: Seeing Surgery Differently

Every day, 650,000 people undergo some form of surgery.

Whether that’s a knee replacement, spinal procedure, or angioplasty, 650,000 people are given new lives and new futures every day; however, with such a massive volume of people going through these procedures, human error and complications can become apparent. Making surgeries more efficient and automated can significantly reduce costs, recovery time, and accidents, and that is exactly what augmented reality (AR) technologies are improving in hospitals today.

When the costs for surgery falls, it can allow many more people to afford to pay for emergency surgical procedures and reduce waiting times drastically. This article will showcase the many resourceful ways that AR is being used to complement the abilities of surgeons, and how it is helping make life easier for millions of people across the world.

A Basic Overview of AR:

Augmented reality is one technology in a larger array of reality-altering devices, such as virtual and mixed reality. Currently, these technologies use external head-mounted displays (HMDs) to either partially or completely project computer-generated video onto the user’s natural view.

Augmented technology is the most popular among surgeons, as they require both physical and computational feedback during an operation.

Virtual reality focuses on creating a fully immersive, alternate environment for the user. Augmented reality projects images and indicators onto the user’s current view of their surroundings, which can be useful for situations where the user requires feedback from both their actual surroundings and a computer, such as piloting jets, or conducting surgically intensive procedures such as bone reconstruction and vein removal.

Spinal Fusions

In the year of 2014, over 1.62 million people in America alone went through spinal surgery, with over 350,000 of them being spinal fusions. Spinal fusions are usually performed to treat scoliosis — pedicle screws and steel rods are used to set two vertebrae in place so that they can fuse properly.

Although this life-changing surgery is the most common method of treating scoliosis, reports suggest that only 80% of patients are satisfied with their surgeries, mainly because of complications such as spinal breaches, where the pedicle screw passes through the spinal cord and causes paralysis.

Surgeons planning a pedicle screw insertion with an AR projection of the patient’s 3-D spine model extracted from a series of 2-D MRI images.

AR headsets such as the Microsoft HoloLens are being used to project guidelines onto the patient’s vertebrae during surgery to indicate the safest screw placement locations that pose the least possible risk of a breach. In clinical studies, HMDs being used to enhance this surgery showed sub-millimetre accuracy in screw placement, as well as 5–10% improvement in patient satisfaction.

Virtual Training

Maintaining the vast expertise and knowledge of surgeons, as well as evaluating the skill of surgeons-in-training is a key factor in reducing complications, and this is usually done with written tests or real-life scenario practice on cadavers. This is a major cost to the government and can be fully digitized with AR.

A surgeon being trained with a robotic-AR technology that takes in joystick input from a physical scalpel. The procedure is being simulated on a digitized spinal model.

AR is transforming the field of medical education, as it can display any part of the body, requires no physical cadavers, and can be programmed to display unlikely scenarios and mishaps to test the knowledge of the surgeon. Haptic feedback can also be implemented to assess the pressure a surgeon applies on a specific cut, as well as for robotic AR surgeries.

Surgical Planning

For many complex surgical tasks, surgical groups hold planning sessions to discuss the process of the surgery, as well as techniques that can be implemented. The majority of surgical planning is performed with the patient’s medical record and sets of CT and MRI scans. These 2-D images; however, do not usually provide the surgical team with enough spatial context to derive new insight into the procedure.

Surgical planning software is being programmed for use in robotic surgery, letting surgeons “program” a set of semi-automated surgical instructions into a robotic surgeon requiring minimal supervision.

A surgeon planning a liver surgery with a tactile pointer.

AR has gained popularity in the field of procedural surgical planning through dedicated software applications that allow teams of surgeons, anesthetists, and nurses to create a customized, step-by-step surgical process tailored to a 3D-rendered image of the region of interest, such as the patient’s heart, or brain. In-hospital tests for these systems have shown, on average, a 20% decrease in planning time, as well as reports of increased surgical efficiency by surgeons.

Cancer Removal

Many non-aggressive tumours can be surgically removed or cauterized, yet surgeons face the problem of differentiating between healthy and cancerous tissue since they are roughly identical in terms of density, colour, and texture.

Cancer removal surgeries, encompassing tumour removal, and ablation (cauterization), collectively form the second most widely performed surgical procedure, topped only by C-Sections. Patients of tumour removal surgeries have experienced many adverse side effects, such as accidental loss of large volumes of healthy tissue, as well as cancer remission as a result of failing to remove all cancerous tissue.

A handheld device used to project cancer areas onto the brain.

Four months ago, researchers tested the viability of combining a handheld mass spectrometer with AR technology to indicate cancerous regions to surgeons. The mass spectrometer device detects the specific molecular composition of cancer, which is fed into a computer and projected onto the surgeon’s field of view as a cancer “heat map”. Computational trials showed a near-doubling of cancer tissue removal in terms of volume, as well as maintaining previous levels of healthy tissue.

Further exploration in this field could result in significantly reduced surgical times for cancer patients, less time spent in hospital care, and billions of saved healthcare dollars that can be reinvested into cancer research, or used for other important initiatives.

Conclusion

The vast field of augmented reality (AR) devices are revolutionizing our view of surgical procedures through applications such as spinal fusions, virtual training, surgical planning, as well as cancer removal. These devices are already helping surgeons by reducing costs, increasing safety, and making surgery a viable treatment option for billions of people around the globe.

In the end, surgeries and medicine are a small branch of the ever-growing tree of possibilities that AR presents, and we have only scratched the surface of ways that augmented reality can impact our society for the better.

Thank you for reading!