Breaking News
December 13, 2018 - Chronic rhinitis associated with hospital readmissions for asthma and COPD patients
December 13, 2018 - Food poisoning discovery could save lives
December 13, 2018 - Cloned antibodies show potential to treat, diagnose life-threatening fungal infections
December 13, 2018 - Exercise may reduce colorectal cancer risk after weight loss
December 13, 2018 - Russian scientists create hardware-information system for brain disorders treatment
December 13, 2018 - Moderate alcohol consumption linked with lower risk of hospitalization
December 13, 2018 - Nurturing Healthy Neighborhoods | NIH News in Health
December 13, 2018 - Rise in meth and opioid use during pregnancy
December 13, 2018 - Researchers gain new insights into pediatric tumors
December 13, 2018 - FSU study finds racial disparity among adolescents receiving flu vaccine
December 13, 2018 - Drug cocktail induces cancer cell death by switching off energy supply
December 13, 2018 - Baculovirus virion completely eliminates liver-stage parasites in mouse model
December 13, 2018 - Researchers create noninvasive technology that detects when nerve cells fire
December 13, 2018 - Treating patients with hypertension induced albuminuria
December 13, 2018 - New substance could improve efficacy of established breast cancer treatments
December 13, 2018 - Scientists develop new stem cell line to study conversion of stem cells into muscle
December 13, 2018 - Re-programming the body’s energy pathway boosts kidney self-repair
December 13, 2018 - Research findings could help improve treatment of anxiety and post-traumatic stress disorders
December 13, 2018 - The Microbiome Movement announce Microbiotica as official industry partner
December 13, 2018 - New study reveals potential benefits of cEEG monitoring for infant ICU patients
December 13, 2018 - Whole-body imaging PET/MRI offers information to guide treatment options for prostate cancer
December 13, 2018 - International investigators fight against the negative campaign on benzodiazepines
December 13, 2018 - Targeting biochemical pathway may lead to new therapies for alleviating symptoms of anxiety disorders
December 13, 2018 - FDA Approves Tolsura (SUBA®-itraconazole capsules) for the Treatment of Certain Fungal Infections
December 13, 2018 - Are scientists studying the wrong kind of mice?
December 13, 2018 - Computer memory: A scientific team builds a virtual model of a key brain region
December 13, 2018 - Visual inspection alone is insufficient to diagnose skin cancer
December 13, 2018 - Paternal grandfather’s access to food associated with grandson’s mortality risk
December 13, 2018 - Our brain senses angry voices in a flash, study shows
December 13, 2018 - PM2.5 Exposure Linked to Asthma Rescue Medication Use
December 13, 2018 - Can’t exercise? A hot bath may help improve inflammation, metabolism, study suggests
December 13, 2018 - Can artificial intelligence help doctors with the human side of medicine?
December 13, 2018 - Virginia Tech and UC San Diego researchers team up to develop nonopioid drug for chronic pain
December 13, 2018 - NIH offers support for HIV care and prevention research in the southern United States
December 12, 2018 - Activating brain region could revive the urge to socialize among opioid addicts
December 12, 2018 - Relationship impairment appears to interfere with seeking mental health treatment in men
December 12, 2018 - Sleep, Don’t Cram, Before Finals for Better Grades
December 12, 2018 - Effective treatments for urticarial vasculitis
December 12, 2018 - Gun violence is a public health issue: One physician’s story
December 12, 2018 - The Science of Healthy Aging
December 12, 2018 - Yes to yoghurt and cheese: New improved Mediterranean diet
December 12, 2018 - Researchers uncover a number of previously unknown insecticide resistance mechanisms
December 12, 2018 - Regulating the immune system’s ‘regulator’
December 12, 2018 - In breaking bad news, the comfort of silence
December 12, 2018 - Study finds upward link between alcohol consumption and physical activity in college students
December 12, 2018 - FDA issues warning letter to Zhejiang Huahai Pharmaceutical involved in valsartan recall
December 12, 2018 - Weight history at ages 20 and 40 could help predict patients’ future risk of heart failure
December 12, 2018 - Presence of antiphospholipid antibodies tied to first-time MI
December 12, 2018 - DNA analysis finds that stethoscopes are teaming with bacteria
December 12, 2018 - New study could help inform research on preventing falls
December 12, 2018 - Women and men with heart attack symptoms receive different care from EMS
December 12, 2018 - Disrupted biological clock can contribute to onset of diseases, USC study shows
December 12, 2018 - New publications generate controversy over the value of reducing salt consumption in populations
December 12, 2018 - New data from TAILORx trial confirms lack of chemo benefit regardless of race or ethnicity
December 12, 2018 - Specific class of biomarkers can accurately indicate the severity of cancer
December 12, 2018 - Meds Taken Do Not Vary With ADL Impairment in Heart Failure
December 12, 2018 - Long-term study shows that HIV-2 is deadlier than previously thought
December 12, 2018 - People living near oil and gas wells show early signs of cardiovascular disease
December 12, 2018 - IONTAS founder and pioneer in phage display technology attends Nobel Prize Award Ceremony
December 12, 2018 - People who eat red meat have high levels of chemical associated with heart disease, study finds
December 12, 2018 - New method uses water molecules to unlock neurons’ secrets
December 12, 2018 - Genetics study offers hope for new acne treatment
December 12, 2018 - New computer model predicts prostate cancer progression
December 12, 2018 - Nobel Laureates lecture about immune checkpoint therapy for cancer treatment
December 12, 2018 - More Illnesses From Tainted Romaine Lettuce Reported
December 12, 2018 - Aspirin could reduce HIV infections in women
December 12, 2018 - The EORTC Brain Tumor Group and Protagen AG collaborate to study immuno-competence of long-term glioblastoma survivors
December 12, 2018 - Insights into magnetotactic bacteria could guide development of biological nanorobots
December 12, 2018 - Sacrificial immune cells alert body to infection
December 12, 2018 - Low-salt diet may be more beneficial for females than males
December 12, 2018 - Major soil organic matter compound battles chronic wasting disease
December 12, 2018 - Findings may open up new ways to treat dwarfism and other ER-stress-related conditions
December 12, 2018 - New computational model provides clearer picture of shape-changing cells’ structure and mechanics
December 12, 2018 - 10 Facts on Patient Safety
December 12, 2018 - Poorest dying nearly 10 years younger than the rich in ‘deeply worrying’ trend for UK
December 12, 2018 - Innovative care model for children with ASD reduces use of behavioral drugs in ED
December 12, 2018 - Spending time in and around Hong Kong’s waters linked to better health and wellbeing
December 12, 2018 - Simple measures to prevent weight gain over Christmas
December 12, 2018 - Research advances offer hope for patient-tailored AML treatment
December 12, 2018 - Researchers discover a ‘blind spot’ in atomic force microscopy
Augmented Reality helps surgeons to ‘see through’ tissue and reconnect blood vessels

Augmented Reality helps surgeons to ‘see through’ tissue and reconnect blood vessels

image_pdfDownload PDFimage_print
The surgeon’s view. Credit: ‘Philip Pratt, et al. Eur Radiol Exp, 2018’

Using augmented reality in the operating theatre could help surgeons to improve the outcome of reconstructive surgery for patients.

In a series of procedures carried out by a team at Imperial College London at St Mary’s Hospital, researchers have shown for the first time how surgeons can use Microsoft HoloLens headsets while operating on patients undergoing reconstructive lower limb surgery.

The HoloLens is a self-contained computer headset that immerses the wearer in ‘mixed reality’, enabling them to interact with ‘holograms’ – computer-generated objects made visible through the visor. In the UK, headsets are currently only available for developers.

The Imperial team used the technology to overlay images of CT scans – including the position of bones and key blood vessels – onto each patient’s leg, in effect enabling the surgeon to ‘see through’ the limb during surgery.

According to the team trialling the technology, the approach can help surgeons locate and reconnect key blood vessels during reconstructive surgery, which could improve outcomes for patients.

“We are one of the first groups in the world to use the HoloLens successfully in the operating theatre,” said Dr Philip Pratt, a Research Fellow in the Department of Surgery & Cancer and lead author of the study, published in European Radiology Experimental. “Through this initial series of patient cases we have shown that the technology is practical, and that it can provide a benefit to the surgical team. With the HoloLens, you look at the leg and essentially see inside of it. You see the bones, the course of the blood vessels, and can identify exactly where the targets are located.”

Following a car accident or severe trauma, patients may have tissue damage or open wounds that require reconstructive surgery using fasciocutaneous flaps. These flaps of tissue, which are taken from elsewhere on the body and include the skin and blood vessels, are used to cover the wound and enable it to close and heal properly.

A vital step in the process is connecting the blood vessels of the ‘new’ tissue with those at the site of the wound, so oxygenated blood can reach the new tissue and keep it alive.

The standard approach for this element of reconstructive surgery has been the use of a handheld scanner which uses ultrasound to identify blood vessels under the skin by detecting the movement of blood pulsing through them, enabling the surgeon to approximate where the vessels are and their course through the tissue.

“Augmented reality offers a new way to find these blood vessels under the skin accurately and quickly by overlaying scan images onto the patient during the operation,” explained Dr Pratt.

Making the model

In the procedures used to trial the technology, five patients requiring reconstructive surgery on their legs underwent CT scans to map the structure of the limb, including the position of bones and the location and course of blood vessels.

Images from the scans were then segmented into bone, muscle, fatty tissue and blood vessels by Dr Dimitri Amiras, a consultant radiologist at Imperial College Healthcare NHS Trust (ICHNT), and loaded into intermediary software to create 3D models of the leg.

These models were then fed into specially designed software that renders the images for the HoloLens headset, which in turn overlays the model onto what the surgeon can see in the operating theatre. Clinical staff are able to manipulate these AR images through hand gestures to make any fine adjustments and correctly line up the model with surgical landmarks on the patient’s limbs, such as the knee joint or ankle bone.

Dr Amiras said: “St Mary’s Hospital is a major trauma centre, giving us the opportunity to try and improve the pre-operative planning for reconstructive flaps. Over time, the scanning protocol has been optimised to give excellent images of the anatomy, however, at first we had to rely on rough measurements of anatomical landmarks taken from 3D CT reconstructions to guide surgery.

“Now, using the HoloLens, we can identify where the blood vessels are in 3D space and use virtual 3D arrows to guide the surgeon. Currently, data preparation is a time consuming process, but in the future much of this could be automated, with the consultant radiologist checking the accuracy of the model against the original scan. I think this is a great example of what can be achieved in an Academic Health Science Centre.”

The surgeon’s view

Mr Jon Simmons, a plastic and reconstructive surgeon at ICHNT, led the team who carried out the procedures using the HoloLens headset and augmented reality models. The cases ranged from a 41-year-old man who had sustained leg injuries during a car accident, to an 85-year-old woman with a compound fractured ankle. The surgical teams reported the HoloLens to be a powerful tool in the theatre, with the approach being more reliable and less time-consuming than the ultrasound method of locating blood vessels.

“The application of AR technology in the operating theatre has some really exciting possibilities,” said Mr Simmons. “It could help to simplify and improve the accuracy of some elements of reconstructive procedures. While the technology can’t replace the skill and experience of the clinical team, it could potentially help to reduce the time a patient spends under anaesthetic and reduce the margin for error. We hope that it will allow us to provide more tailored surgical solutions for individual patients.”

The group highlights a few limitations with the technology, which could include errors during the modelling stages as well as the potential for the overlaid model to be misaligned. In addition, the case studies so far have been based on the leg, which has a number of clearly visible surgical ‘landmarks’, such as the ankle or knee. Areas without these rigid landmarks, such as abdomen, may be more complicated with a greater potential for movement of blood vessels.

However, the researchers are confident that, once refined, the approach could be applied to other areas of reconstructive surgery requiring tissue flaps, such as breast reconstruction following mastectomy. The next steps include trialling the technology in a larger set of patients, with procedures carried out by teams at multiple centres.

Dr Pratt added: “In future we hope to automate the process further. We can use software to improve the alignment and will attach markers to the patient when they have the scan, with the same markers present during the operation to use as additional points of reference. There are a number of areas we would like to explore, and further improvements are needed, but the small case series has shown that for reconstructive surgery, this seems to be a valuable tool in the operating theatre.”


Explore further:
Augmented reality technology may help guide plastic and reconstructive surgery

More information:
Philip Pratt et al, Through the HoloLens looking glass: augmented reality for extremity reconstruction surgery using 3D vascular models with perforating vessels, European Radiology Experimental (2018). DOI: 10.1186/s41747-017-0033-2

Provided by:
Imperial College London

Tagged with:

About author

Related Articles