Augmented Reality (AR) is a technology that can allow a surgeon to see subsurface structures. This works by overlaying information from another modality, such as MRI and fusing it in real time with the endoscopic images. AR has never been developed for a very mobile organ like the uterus and has never been performed for gynecology. Myomas are not always easy to localize in laparoscopic surgery when they do not significantly change the surface of the uterus, or are at multiple locations.
To study the accuracy of myoma localization using a new AR system compared to MRI-only localization.
Ten residents were asked to localize six myomas (on a uterine model into a laparoscopic box) when either using AR or in conditions that simulate a standard method (only the MRI was available). Myomas were randomly divided in two groups: the control group (MRI only, AR not activated) and the AR group (AR activated). Software was used to automatically measure the distance between the point of contact on the uterine surface and the myoma. We compared these distances to the true shortest distance to obtain accuracy measures. The time taken to perform the task was measured, and an assessment of the complexity was performed.
The mean accuracy in the control group was 16.80 mm [0.1–52.2] versus 0.64 mm [0.01–4.71] with AR. In the control group, the mean time to perform the task was 18.68 [6.4–47.1] s compared to 19.6 [3.9–77.5] s with AR. The mean score of difficulty (evaluated for each myoma) was 2.36 [1–4] versus 0.87 [0–4], respectively, for the control and the AR group.
We developed an AR system for a very mobile organ. This is the first user study to quantitatively evaluate an AR system for improving a surgical task. In our model, AR improves localization accuracy.
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We want to thank Rochette E. and Comptour A. (assistance in proofreading the article).
N. Bourdel, T. Collins, D. Pizarro, A. Bartoli, D. Da Ines, B. Pereira, M. Canis have no conflicts of interest or financial ties to disclose.
Electronic supplementary material
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Virtual MRI of the uterus model. Top left, top right and bottom left show axial, sagittal and coronal slices, respectively. Bottom right show slices oriented in the 3D volume. (TIFF 1521 kb)
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Bourdel, N., Collins, T., Pizarro, D. et al. Augmented reality in gynecologic surgery: evaluation of potential benefits for myomectomy in an experimental uterine model. Surg Endosc 31, 456–461 (2017) doi:10.1007/s00464-016-4932-8
- Gynecologic surgery
- Augmented Reality