Combination of CAD/CAM and Augmented Reality in Free Fibula Bone Harvest

Abstract

Summary: The CAD/CAM technology for mandibular reconstruction has improved the results in terms of outcomes in restoring mandibular complex defects. Augmented reality (AR) represents an evolution of the navigation-assisted surgery. This technology merges the images of the virtual planning with the anatomy of the patient, representing in this way an enhanced scene for the surgeon’s eye. AR can also display in a single scene additional information for the surgeon. Despite of classical navigation, this scenario can be obtained with marker-less registration method, without using reference points or fiducial markers. This technologic evolution together with the large use in our experience of CAD/CAM protocol for mandibular reconstruction we developed this feasibility study to evaluate the possibility of using a marker-less image registration system. Moreover, we tried to evaluate the overlaying of the virtual planning and its reproducibility using AR. We performed a case series of 3 consecutive patients who underwent mandibular reconstruction using AR-assisted fibular free flap harvesting applying our digital workflow. Once launched, the mobile app installed on our tablet, the registration is performed according to a shape recognition system of the leg of the patient, rendering in real time a superimposition of the anatomy of the bony, vascular, and skin of the patient and also the surgical planning of the reconstruction. AR-assisted fibular free flap harvesting was performed. We believe that AR can be a prospective improving technology for mandibular complex reconstruction.

The Wearable VOSTARS System for Augmented Reality-Guided Surgery: Preclinical Phantom Evaluation for High-Precision Maxillofacial Tasks

“…The VOSTARS device can have prospective use also in tumor and head and neck reconstructive surgery, e.g., in providing anatomical visualization and in supporting mandibular complex reconstruction. Some previous studies reported experiences of AR-assisted navigation used in combination with CAD/CAM technology to guide the positioning of the fibular osteotomy cutting guide [7], as well as to facilitate anatomical visualization during free flap harvesting [42], but in both cases, the AR guidance was performed using hand-held mobile devices (smartphone or tablet). VOSTARS can represent an improved AR-assisted navigation system that allows the surgeon to view directly in front of his eyes the virtual content superimposed on the patient.…”

“…In the last two decades, new tools based on three-dimensional (3D) imaging and advanced digital technologies have become available to surgeons during pre-, intra-and postoperative phases of an intervention in the cranio-maxillofacial field [4][5][6][7][8], as well as in other surgical specialties, such as neurology, urology, vascular surgery, orthopedics [9][10][11][12][13][14][15][16][17].…”

Augmented Reality to Guide Selective Clamping and Tumor Dissection During Robot-assisted Partial Nephrectomy: A Preliminary Experience

“…11,15 An additional step towards the precise medicine and imaging-guided surgery is the adoption of augmented reality (AR) in different surgical interventions. [16][17][18][19][20][21][22] During PN, the AR technology can facilitate a rapid and accurate anatomic identification of the renal vasculature.…”

Augmented Reality-Assisted Periosteum Pedicled Flap Harvesting for Head and Neck Reconstruction: An Anatomical and Clinical Viability Study of a Galeo-Pericranial Flap

“…New computer-assisted technologies assist head and neck surgeons in clinical practice [ 10 , 11 ], as does augmented reality (AR). We recently used AR to facilitate anatomical visualisation during free flap harvesting [ 12 ]. Augmented reality merges virtual and actual objects, allowing direct observation of patient anatomy and the surgical field.…”

“…This enhances the surgeon’s view of the physical environment without any need for invasive preoperative placement of fixed fiducial markers. Augmented reality offers real-time image registration without the need for markers [ 12 ].…”