Virtual Reality, Intraoperative Navigation, and Telepresence Surgery

  • M. Peter HeilbrunEmail author
Part of the Topics in Biomedical Engineering International Book Series book series (ITBE)


A part of the expertise of the operating surgeon is the practiced development of motor skills. These skills are attained by practice in multiple environments, including the animal laboratory and the operating room. The surgeon starts as a surgical assistant and gradually is granted increased responsibilities in performing the critical portions of operative procedures. Building on many years of experience using types of radiographic images of the brain and spine for intraoperative navigation, neurosurgeons, working with bioengineers and computer scientists, have developed methods of image-guided computer-assisted and computer-directed operative procedures using anatomic and pathologic structures identified in volumetric three dimension reformatted brain and spine images co-registered to the physical operative workspace using a variety of three-dimensional digitizers. With the computation power available today, such image sets can be used to create a virtual environment within which a surgeon could realistically both practice skills and attain new skills. This can now be accomplished with partial immersion. It is realistic to contemplate in the near future a total immersion environment realistically simulating all of the sensations and forces associated with an actual operative field. We have termed this development a “surgical holodeck.” This chapter reviews the development and application of these methods, which are the foundation of a simulation environment close to the real operative suite.


Virtual Reality Operating Microscope Cranial Vault Surgical Navigation Partial Immersion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

5. References

  1. 1.
    Adler Jr JR, Chang SD, Murphy MJ, Doty J, Geis P, Hancock SL. 1997. The CyberKnife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 69(1–4 pt 2):124–128.PubMedCrossRefGoogle Scholar
  2. 2.
    Angood PB, Satava R, Doarn C, Merrell R; E3 Group. 2000. Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions. Telemed JE Health 6(3):315–325.CrossRefGoogle Scholar
  3. 3.
    Argenziano M. 2003. Totally endoscopic, robotic cardiac surgery. Heart Surg Forum 6(2):104.Google Scholar
  4. 4.
    Argenziano M, Oz MC, DeRose Jr JJ, Ashton Jr RC, Beck J, Wang F, Chitwood WR, Nifong LW, Dimitui J, Rose EA, Smith Jr CR. 2002. Totally endoscopic atrial septal defect repair with robotic assistance. Heart Surg Forum 5(3):294–300.PubMedGoogle Scholar
  5. 5.
    Benebid AL, Cinquin P, Lavalle S, Le Bas JF, Demongeot J, de Rougemont J. 1987. Computer-driven robot for stereotactic surgery connected to CT scan and magnetic resonance imaging: technological design and preliminary results. Appl Neurophysiol 50:153–154.CrossRefGoogle Scholar
  6. 6.
    Brown RA. 1979. A computed tomography-computer graphics approach to stereotactic localization. J Neurosurg 50:715–720.PubMedGoogle Scholar
  7. 7.
    Brown RA, Roberts TS, Osborne AG. 1980. Stereotaxic frame and computer software for CT-directed neurosurgical localization. Invest Radiol 15(4):308–312.PubMedCrossRefGoogle Scholar
  8. 8.
    Bucholz RD, Greco DJ. 1996. Image-guided surgical techniques for infections and trauma of the central nervous system. Neurosurg Clin N Am 7(2):187–200.PubMedGoogle Scholar
  9. 9.
    Chang SD, Main W, Martin DP, Gibbs IC, Heilbrun MP. 2003. An analysis of the accuracy of the CyberKnife: a robotic frameless stereotactic radiosurgical system. Neurosurg 52(1):146–147.CrossRefGoogle Scholar
  10. 10.
    Dandy WE. 1918. Ventriculography following injection of air into the cerebral ventricles. Ann Surg 68:1–5.CrossRefGoogle Scholar
  11. 11.
    Donaghy RM, Yasargil G. 1968. Microangeional surgery and its techniques. Prog Brain Res 30:263–267.PubMedCrossRefGoogle Scholar
  12. 12.
    Friets EM, Strohbehn JW, Hatch JF, Roberts DW. 1989. A frameless stereotaxic operating microscope for neurosurgery. IEEE Trans Biomed Eng 36(6):608–617.PubMedCrossRefGoogle Scholar
  13. 13.
    Horsley V, Clarke LH. 1908. The structure and functions of the cerebellum examined by a new method. Brain 31:45–124.CrossRefGoogle Scholar
  14. 14.
    Kall BA, Kelly PJ, Goerss SJ. 1985. Interactive stereotactic surgical system for the removal of intracranial tumors utilizing the CO2 laser and CT-derived database. IEEE Trans Biomed Eng 32(2):112–116.PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly PJ. 1987. Future possibilities in stereotactic surgery: where are we going? Appl Neurophysiol 50(1–6):1–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Kelly PJ. 1991. Computer-assisted volumetric stereotactic resection of superficial and deep seated intra-axial brain mass lesions. Acta Neurochir Suppl (Wien) 52:26–29.Google Scholar
  17. 17.
    Kelly PJ. 1992. Stereotactic resection and its limitations in glial neoplasms. Stereotact Funct Neurosurg 59(1–4):84–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Kwoh YS, Young RF, eds. 1992. Robotic-aided surgery: computers in stereotactic neurosurgery. Blackwell Scientific Publications, Oxford.Google Scholar
  19. 19.
    Leksell L, Jernberg B. 1980. Stereotaxis and tomography: a technical note. Acta Neurochir (Wien) 52(1–2):1–7.CrossRefGoogle Scholar
  20. 20.
    Moniz E. 1927. L’encephalographie arterielle: sons importance dans la localisation des tumeurs cerebrates. Rev Neurol 34:72–90.Google Scholar
  21. 21.
    Ottensmeyer MP, Ben-Ur E, Salisbury JK. 2000. Input and output for surgical simulation: devices to measure tissue properties in vivo and a haptic interface for laparoscopy simulators. Stud Health Technol Inform 70:236–242.PubMedGoogle Scholar
  22. 22.
    Roberts DW, Strohbehn JW, Friets EM, Kettenberger J, Hartov A. 1989. The stereotactic operating microscope: accuracy refinement and clinical experience. Acta Neurochir Suppl (Wien) 46:112–114.Google Scholar
  23. 23.
    Satava RM. 1999. Emerging technologies for surgery in the 21st century. Arch Surg 134(11):1197–1202.PubMedCrossRefGoogle Scholar
  24. 24.
    Shahidi R, Clarke L, Bucholz RD, Fuchs H, Kikinis R, Robb RA, Vannier MW. 2001. White paper: challenges and opportunities in computer-assisted interventions January 2001. Comput-Aided Surg 6(3):176–181.PubMedCrossRefGoogle Scholar
  25. 25.
    Smith KR, Frank KJ, Bucholz RD. 1994. The NeuroStation: a highly accurate, minimally invasive solution to frameless stereotactic neurosurgery. Comput Med Imaging Graph 18(4):247–256.PubMedCrossRefGoogle Scholar
  26. 26.
    Spiegel EA, Wycis HT, Marks M, Lee AJ. 1947. Stereotactic apparatus for operations on the human brain. Science 106:349–350.CrossRefPubMedGoogle Scholar
  27. 27.
    Watanabe E, Watanabe T, Manaka S, Mayanagi Y, Takakura K. 1987. Three-dimensional digitizer (neuronavigator): new equipment for computed tomography-guided stereotaxic surgery. Surg Neurol 27(6):543–547.PubMedCrossRefGoogle Scholar
  28. 28.
    Westermann B, Trippel M, Reinhardt H. 1995. Optically navigable operating microscope for image-guided surgery. Minim Invas Neurosurg 38:112–116.CrossRefGoogle Scholar

Copyright information

© Springer Inc. 2006

Authors and Affiliations

  1. 1.Department of NeurosurgeryStanford University Medical CenterStanford

Personalised recommendations