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Pulumati A, Algarin YA, Jaalouk D, Hirsch M, Nouri K. Exploring the potential role for extended reality in Mohs micrographic surgery. Arch Dermatol Res 2024; 316:67. [PMID: 38194123 DOI: 10.1007/s00403-023-02804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/03/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
Mohs micrographic surgery (MMS) is a cornerstone of dermatological practice. Virtual reality (VR) and augmented reality (AR) technology, initially used for entertainment, have entered healthcare, offering real-time data overlaying a surgeon's view. This paper explores potential applications of VR and AR in MMS, emphasizing their advantages and limitations. We aim to identify research gaps to facilitate innovation in dermatological surgery. We conducted a PubMed search using the following: "augmented reality" OR "virtual reality" AND "Mohs" or "augmented reality" OR "virtual reality" AND "surgery." Inclusion criteria were peer-reviewed articles in English discussing these technologies in medical settings. We excluded non-peer-reviewed sources, non-English articles, and those not addressing these technologies in a medical context. VR alleviates patient anxiety and enhances patient satisfaction while serving as an educational tool. It also aids physicians by providing realistic surgical simulations. On the other hand, AR assists in real-time lesion analysis, optimizing incision planning, and refining margin control during surgery. Both of these technologies offer remote guidance for trainee residents, enabling real-time learning and oversight and facilitating synchronous teleconsultations. These technologies may transform dermatologic surgery, making it more accessible and efficient. However, further research is needed to validate their effectiveness, address potential challenges, and optimize seamless integration. All in all, AR and VR enhance real-world environments with digital data, offering real-time surgical guidance and medical insights. By exploring the potential integration of these technologies in MMS, our study identifies avenues for further research to thoroughly understand the role of these technologies to redefine dermatologic surgery, elevating precision, surgical outcomes, and patient experiences.
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Affiliation(s)
- Anika Pulumati
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| | | | - Dana Jaalouk
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Melanie Hirsch
- University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
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Randazzo G, Reitano G, Carletti F, Iafrate M, Betto G, Novara G, Dal Moro F, Zattoni F. Urology: a trip into metaverse. World J Urol 2023; 41:2647-2657. [PMID: 37552265 PMCID: PMC10582132 DOI: 10.1007/s00345-023-04560-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE Metaverse is becoming an alternative world in which technology and virtual experiences are mixed with real life, and it holds the promise of changing our way of living. Healthcare is already changing thanks to Metaverse and its numerous applications. In particular, Urology and urologic patients can benefit in many ways from Metaverse. METHODS A non-systematic literature review identified recently published studies dealing with Metaverse. The database used for this review was PubMed, and the identified studies served as the base for a narrative analysis of the literature that explored the use of Metaverse in Urology. RESULTS Virtual consultations can enhance access to care and reduce distance and costs, and pain management and rehabilitation can find an incredible support in virtual reality, reducing anxiety and stress and improving adherence to therapy. Metaverse has the biggest potential in urologic surgery, where it can revolutionize both surgery planning, with 3D modeling and virtual surgeries, and intraoperatively, with augmented reality and artificial intelligence. Med Schools can implement Metaverse in anatomy and surgery lectures, providing an immersive environment for learning, and residents can use this platform for learning in a safe space at their own pace. However, there are also potential challenges and ethical concerns associated with the use of the metaverse in healthcare. CONCLUSIONS This paper provides an overview of the concept of the metaverse, its potential applications, challenges, and opportunities, and discusses the implications of its development in Urology.
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Affiliation(s)
- Gianmarco Randazzo
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giuseppe Reitano
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Filippo Carletti
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Massimo Iafrate
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giovanni Betto
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Fabrizio Dal Moro
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
| | - Fabio Zattoni
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, 35122 Padua, Italy
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Pini C, Bottoni E, Fiz F, Giudici VM, Alloisio M, Testori A, Rodari M, Sollini M, Chiti A, Cariboni U, Antunovic L. Radioisotope-Guided Excision of Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Carcinoma: Feasibility and Clinical Impact. Cancers (Basel) 2023; 15:3320. [PMID: 37444438 DOI: 10.3390/cancers15133320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Intraoperative localisation of nodal disease in non-small cell lung cancer (NSCLC) can be challenging. Lymph node localisation via radiopharmaceuticals is used in many conditions; we tested the feasibility of this approach in NSCLC. METHODS NSCLC patients were prospectively recruited. Intraoperative peri-tumoral injections of [99mTc]Tc-albumin nanocolloids were performed, followed by removing the tumour and locoregional lymph nodes. These were examined ex vivo with a gamma probe and labelled sentinel lymph nodes (SLNs) if they showed any activity or non-sentinel lymph nodes (nSLNs) if they did not. Thereafter, the surgical field was scanned with the probe; any further radioactive lymph node was removed and labelled as "extra" SLNs (eSLNs). All specimens were sent to histology, and metastatic status was recorded. RESULTS 48 patients were enrolled, and 290 nodal stations were identified: 179 SLNs, 87 nSLNs, and 24 eSLNs. A total of 44 nodal metastases were identified in 22 patients, with 36 of them (82%) located within SLNs. Patients with nSLNs metastases had at least a co-existing positive SLN. No metastases were found in eSLNs. CONCLUSIONS The technique shows high sensitivity for intraoperative nodal metastases identification. This information could allow selective lymphadenectomies in low-risk patients or more aggressive approaches in high-risk patients.
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Affiliation(s)
- Cristiano Pini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Francesco Fiz
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Ente Ospedaliero "Ospedali Galliera", 16128 Genoa, Italy
- Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Veronica Maria Giudici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Marcello Rodari
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Umberto Cariboni
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Lidija Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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Wan SM. Gamma camera imaging of sentinel lymph nodes in early stage oral cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mondal SB, Achilefu S. Virtual and Augmented Reality Technologies in Molecular and Anatomical Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The First Clinical Use of Augmented Reality to Treat Salivary Stones. Case Rep Dent 2020; 2020:5960421. [PMID: 32695526 PMCID: PMC7368961 DOI: 10.1155/2020/5960421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/02/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we report our first experience of applying the concretion visualization method using augmented reality technology. A clinical case of a new surgical intervention on the parotid salivary gland with the localization of salivary stone in its parenchyma is considered. During additional diagnostics, it was found that the size of the concretion exceeds 5 mm which did not allow us to use the endoscopic technologies. That was the reason for the choice of surgical intervention external access using salivary stone visualization with the help of augmented reality. The preoperative procedures included making the upper jaw cast model, fitting the model and individual mouthguard with an X-ray contrast marker and marker slot. In addition to this, computed tomography of the head and neck using a mouthguard was made. During surgery under general anesthesia with nasal intubation, the mouthguard together with the marker is installed in the patient's mouth and the surgeon puts on the glasses to visualize the stone image in place of its localization. This method enables to visualize the salivary stone on all surgery stages no matter what type of approach is used or performing hydropreparation. That is why using the augmented reality appears promising and is to be studied further.
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Lysenko AV, Razumova AY, Yaremenko AI, Mirzakhmedov RR. [Augmented reality in the treatment of sialolithiasis]. STOMATOLOGII︠A︡ 2020; 99:64-66. [PMID: 32692522 DOI: 10.17116/stomat20209904164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In a clinical case we report on the primary application of modern methods of visualization using augmented reality in the treatment of patients with sialolithiasis for the localization of salivary stone in the parenchyma of the parotid salivary gland. Impression was taken and individual splint with radiopaque marker and a cutout for a probe was made. The splint was used for spiral CT of the head and neck. In surgical intervention under endotracheal anesthesia with intubation through the nose, the splint was placed in the mouth with a tap and a surgeon visualized the projection of the stone on the skin using glasses. The method allows to visualize salivary stone at all stages of surgery, regardless of the type of access or hydrotreatment. However, this technique does not make it possible to estimate the depth of the stone, as well as if the salivary stone is not fixed in the duct there is a risk of changing its position. In this regard, the use of augmented reality has a promising direction and requires further research.
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Affiliation(s)
- A V Lysenko
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - A Ya Razumova
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - A I Yaremenko
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
| | - R R Mirzakhmedov
- I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
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Yao J, Zeng W, Zhou S, Cheng J, Huang C, Tang W. Augmented Reality Technology Could Be an Alternative Method to Treat Craniomaxillofacial Foreign Bodies: A Comparative Study Between Augmented Reality Technology and Navigation Technology. J Oral Maxillofac Surg 2020; 78:578-587. [DOI: 10.1016/j.joms.2019.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 12/11/2022]
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Pérez-Pachón L, Poyade M, Lowe T, Gröning F. Image Overlay Surgery Based on Augmented Reality: A Systematic Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1260:175-195. [PMID: 33211313 DOI: 10.1007/978-3-030-47483-6_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Augmented Reality (AR) applied to surgical guidance is gaining relevance in clinical practice. AR-based image overlay surgery (i.e. the accurate overlay of patient-specific virtual images onto the body surface) helps surgeons to transfer image data produced during the planning of the surgery (e.g. the correct resection margins of tissue flaps) to the operating room, thus increasing accuracy and reducing surgery times. We systematically reviewed 76 studies published between 2004 and August 2018 to explore which existing tracking and registration methods and technologies allow healthcare professionals and researchers to develop and implement these systems in-house. Most studies used non-invasive markers to automatically track a patient's position, as well as customised algorithms, tracking libraries or software development kits (SDKs) to compute the registration between patient-specific 3D models and the patient's body surface. Few studies combined the use of holographic headsets, SDKs and user-friendly game engines, and described portable and wearable systems that combine tracking, registration, hands-free navigation and direct visibility of the surgical site. Most accuracy tests included a low number of subjects and/or measurements and did not normally explore how these systems affect surgery times and success rates. We highlight the need for more procedure-specific experiments with a sufficient number of subjects and measurements and including data about surgical outcomes and patients' recovery. Validation of systems combining the use of holographic headsets, SDKs and game engines is especially interesting as this approach facilitates an easy development of mobile AR applications and thus the implementation of AR-based image overlay surgery in clinical practice.
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Affiliation(s)
- Laura Pérez-Pachón
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Matthieu Poyade
- School of Simulation and Visualisation, Glasgow School of Art, Glasgow, UK
| | - Terry Lowe
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Head and Neck Oncology Unit, Aberdeen Royal Infirmary (NHS Grampian), Aberdeen, UK
| | - Flora Gröning
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Abstract
OBJECTIVES A mixed reality (MR) headset that enables three-dimensional (3D) visualization of interactive holograms anchored to specific points in physical space was developed for use with lateral skull base anatomy. The objectives of this study are to: 1) develop an augmented reality platform using the headset for visualization of temporal bone structures, and 2) measure the accuracy of the platform as an image guidance system. METHODS A combination of semiautomatic and manual segmentation was used to generate 3D reconstructions of soft tissue and bony anatomy of cadaver heads and temporal bones from 2D computed tomography images. A Mixed-Reality platform was developed using C# programming to generate interactive 3D holograms that could be displayed in the HoloLens headset. Accuracy of visual surface registration was determined by target registration error between seven predefined points on a 3D holographic skull and 3D printed model. RESULTS Interactive 3D holograms of soft tissue, bony anatomy, and internal ear structures of cadaveric models were generated and visualized in the MR headset. Software user interface was developed to allow for user control of the virtual images through gaze, voice, and gesture commands. Visual surface point matching registration was used to align and anchor holograms to physical objects. The average target registration error of our system was 5.76 mm ± 0.54. CONCLUSION In this article, we demonstrate that an MR headset can be applied to display interactive 3D anatomic structures of the temporal bone that can be overlaid on physical models. This technology has the potential to be used as an image guidance tool during anatomic dissection and lateral skull base surgery.
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Abstract
Simulation involves the re-creation of real-life situations, processes, or structures for the purpose of improving safety, effectiveness, and efficiency of health care services: simulation provides a controlled and safe environment for training and assessment. In an age in which regulatory burdens, fiscal challenges, and renewed focus on patient safety increasingly constrain surgical residency programs, innovation in teaching is vital for the future of oral and maxillofacial surgery (OMS) training. Of the simulation technologies in modern day health care education, many have found their way into OMS training. This article reviews these technologies, and some examples of their uses in OMS.
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Affiliation(s)
- Kamal F Busaidy
- Department of Oral and Maxillofacial Surgery, UTHealth-Houston, 7500 Cambridge Street, Suite 6510, Houston, TX 77030, USA.
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Recent Development of Augmented Reality in Surgery: A Review. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:4574172. [PMID: 29065604 PMCID: PMC5585624 DOI: 10.1155/2017/4574172] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 07/03/2017] [Indexed: 12/11/2022]
Abstract
Introduction The development augmented reality devices allow physicians to incorporate data visualization into diagnostic and treatment procedures to improve work efficiency, safety, and cost and to enhance surgical training. However, the awareness of possibilities of augmented reality is generally low. This review evaluates whether augmented reality can presently improve the results of surgical procedures. Methods We performed a review of available literature dating from 2010 to November 2016 by searching PubMed and Scopus using the terms “augmented reality” and “surgery.” Results. The initial search yielded 808 studies. After removing duplicates and including only journal articles, a total of 417 studies were identified. By reading of abstracts, 91 relevant studies were chosen to be included. 11 references were gathered by cross-referencing. A total of 102 studies were included in this review. Conclusions The present literature suggest an increasing interest of surgeons regarding employing augmented reality into surgery leading to improved safety and efficacy of surgical procedures. Many studies showed that the performance of newly devised augmented reality systems is comparable to traditional techniques. However, several problems need to be addressed before augmented reality is implemented into the routine practice.
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Augmented Reality and Wearable Technology in Image-guided Navigation and Preoperative Planning. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1057. [PMID: 27757359 PMCID: PMC5055025 DOI: 10.1097/gox.0000000000001057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/26/2022]
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