Intraoperative Navigation in Aesthetic Plastic Surgery with Augmented Reality: A Pre-Clinical Validation Study
Augmented reality (AR) technology is a type of three-dimensional (3D) technology that allows for visualization and interaction with holograms in the real environment. One potential application of this technology is the use of intraoperative holograms to help guide surgical decision-making and precision. In the present study, the authors sought to investigate the accuracy with which aligned holographical markings could be translated by surgeons into surgical markings on a phantom patient.
Methods/Technique
:A total of 15 trials (n=15) were performed on phantom patients. To create a hologram, surgical markings consisting of 14 points were placed on a mannequin and this was captured with 3D photography. The resulting 3D photograph was converted into a hologram using a third-party application and visualized using an AR headset. The holographic markings were aligned to an unmarked phantom patient using a step-wise manual alignment method. Using a surgical pen, the real phantom was marked based on the position of the overlaid holographical markings. 3D photographs of the resulting marked real phantom were taken, and the accuracy of markings were analyzed using 3D analysis software.
Results/Complications
:Holographic overlay proved to be a highly accurate method of guiding intervention, with an average total error in placement of markings of 1.35 ± .24mm. In addition, there were no significant differences in the accuracy of landmark placement between trials. ANOVA investigation identified a greater error in the accuracy of surgical markings that were further from the midline of the face (p < 0.05).
Conclusion
:This study demonstrates that holographic markings can be accurately translated onto a real-world phantom patient with an average error of less than one millimeter. These data support the notion that AR navigation in facial plastic surgery is feasible in a controlled setting. Future studies should seek to investigate the feasibility of AR navigation in live surgery and assess the impact of intraoperative implementation of AR technology on operating room workflow and efficiency.