Bewertung der Genauigkeit von AR-Navigation mit einem Optical-See-Through Head-Mounted-Display im Vergleich zur konventionellen Navigation bei Bohraufgaben - eine Machbarkeitsstudie.

High-risk neurosurgical procedures, such as pedicle screw placement, require advanced technical skill and experience. Compared to conventional navigation systems (CNS) augmented reality navigation systems (ARNS) can reduce mental transformations and mitigate hand-eye coordination problems [1]. This study compares drilling accuracy with ARNS and CNS support.

Six participants with varying levels of medical experience (2 engineers, medical students, surgeons) were instructed to drill along five pre-planned trajectories with different orientations in SikaBlock M330 material (Sika Industry, Swiss). The drill hand piece and material block were tracked using a Polaris Vicra camera (NDI, ON, Canada). In a cross-over study design, participants were either first supported by an ARNS through the optical-see-through head-mounted display (OST-HMD) Hololens 2 (Microsoft, NM, USA) or a CNS with an external 2D monitor. The ARNS presented the target trajectory on a 3D digital twin within the operating field (Fig 1.), whereas the CNS provided three orthogonal 2D views along with an additional compensatory display (Fig.2). Subsequently, deviations were assessed through postoperative computed tomography scans.

Translational and rotational deviations from the target trajectory are slightly lower with ARNS (1.45 ± 0.7 mm, 0.78 ± 0.52°) compared to CNS (1.75 ± 1.28 mm, 1.51 ± 2.43°), however findings are not significant (t-test, p=0.27 for translational, p=0.12 for rotational). Commonly, pedicle breaches below 2 mm are acceptable [2]. For drilling depth absolute deviations are slightly lower with CNS (-0.97 ± 1.35 mm) compared to ARNS (-1.18 ± 1.11 mm), however findings are not significant (p=0.52).

Further research is needed to determine whether ARNS improves drilling accuracy compared to CNS. In future investigations usability factors like efficiency and user satisfaction must also be considered to explore the potential of ARNS to support safe and successful surgery.

Deib, G., Johnson, A., Unberath, M., Yu, K., Andreß, S., Qian, L., Osgood, G., Navab, N., Hui, F. & Gailloud, P. (2018). Image guided percutaneous spine procedures using an optical see-through head mounted display: proof of concept and rationale. Journal of NeuroInterventional Surgery, 10(12) Aoude, A., Fortin, M., Figueiredo, R., Jarzem, P., Ouellet, J. & Weber, M. H. (2015). Methods to Determine pedicle screw placement accuracy in spine Surgery: A Systematic review. European Spine Journal, 24(5), 990–1004