Augmented Reality and Surgery

How Augmented Reality Can Change Surgical Procedures

A surgeon's new best friend?

January 14, 2019, Bruno Jacobsen

Augmented Reality (AR) has the potential to change several professions. The technology, which overlays "reality" with computer-generated images (and other sensory inputs), is expected to serve as an aid to several jobs of the future. One group of practitioners already beginning to see this is surgeons. In this article, we discuss how AR is changing surgical procedures.

How Augmented Reality Can Change Surgical Procedures


The last few decades have seen several technological advances in surgery-related activities. However, most of them have been confined to diagnostic imaging. And although imaging itself has progressed (MRI, CT scans, ultrasounds, etc.), how these images are displayed has not. In essence, professionals are still left with a bunch of different images, in separate and expensive medical screens.


Doctors are also left to their own imagination when it comes to understanding these. Since the images represent the perspective of the machine, they have to exert effort to understand how they come through in the patient in reality. On top of that, they also have to be quite good at fusing the different types of images in their head, in an attempt to create an accurate representation of the patient.


Enter AR. More and more AR companies - startups and larger companies alike - are attempting to enter this space. But how exactly can AR improve surgical operations?


Applications of AR for surgery

HMD can provide information on patients vital signs

One way augmented reality could participate in surgeries would be through head-mounted displays (HMD). These are similar to current VR glasses, or smartglasses. Without obstructing a doctor's view of the patient, HMD could show the patients vital signs, steps in the surgery, medical images, and so on. This would allow doctors to have all the necessary information right in front of them. At the same time, they could focus on the procedure without having to look away or having their vision obstructed.


3D Projections onto the patient

AR does not necessarily need to come in HMD. AR images can also simply be projected to overlay the patient. By projecting major vessels, nerves, etc., onto a patient during surgery, the safety of the operation can be increased. In addition, you can also reduce the time that it would take to conduct it otherwise.


Indeed, this is one promising application that already has some followers. Last year, the FDA approved the OpenSight Augmented Reality System. OpenSight is the first medical solution for Microsoft's HoloLens that has been cleared for use in pre-operative surgical planning. The software also comes with a teaching version.


Training and assessment

AR tools can also be used to train and assess the skills of various people, whether they are students or surgery residents. Unlike in VR, with AR you can use real-life objects, which provides better tactile feedback. As with VR, you can also test unlikely scenarios, specific scenarios, and so on.


Other uses

The scenarios above are the most obvious scenarios for AR in surgery. However, it has other benefits as well. Firstly, operating rooms (ORs) are expensive, and generally equipped with a variety of screens, all with single purposes, to aid the medical staff. Through AR technology, you could cut down on the medical equipment needed in the OR, potentially leading to cost savings.


Second, according to an article in HBR, since ORs are expensive, there is a big incentive for hospitals to keep the utilization rates as high as possible. This means that, often, less "important" operations are done in emergency rooms or other locations. With less medical staff present, fewer resources, and often more inexperienced surgeons carrying these out, safety and care are not always as good as they could be. AR could change the game and make these secondary procedures almost as safe as those conducted in ORs.


Current challenges

Despite the promise of AR in surgery, it faces some challenges. In an article published in the Journal of Healthcare Engineering, Vávra and colleagues have identified some of the following.


First, the reconstructed images that are to be overlayed need to be done in advance, often with the need of powerful computing and advanced algorithms. Hospitals are not, at the moment, best equipped to deal with this. Not to mention that taking up this challenge requires some significant investment from the institutions. Nevertheless, as time progresses, the adoption of this technology should become cheaper and demand should grow.


Another issue that has been brought up is that of "inattentional blindness." Even if the AR system does not obstruct the field of vision, it is possible that its information causes the surgeon to miss some big - but unexpected - object suddenly appearing. (A great example of this type of blindness is the famous gorilla experiment, which you can watch here.)


A fully-functional AR also assumes a system with no latency. With 5G, it is possible that this will be less of a challenge, but at the moment it remains one. Latency, the short delay experienced between a command its execution, needs to be minimized as much as possible. You can easily imagine a scenario where, in an operation, failure to real-time and low-latency information and feedback can have disastrous consequences - especially if one is to rely on technology instead of the medical staff it replaced. You also want low latency during training and skill assessment, in order to adequately prepare future surgeons and assess their skill level.


Of course there are more challenges. The images need to be displayed perfectly, headsets need to become more comfortable (remember surgeons can operate for hours on end), and so on.


Coming soon?

Challenges aside, it is almost certain that AR will have a great impact on surgical procures. OpenSight's FDA approval is an encouraging sign of that. As the technology becomes more reliable and the prices come down, we are likely to begin seeing more and more AR systems in across hospitals. This is a good thing. Surgeries will be more effective, quick, and safe - something that both hospitals and patients will be happy about.

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