Review and Future/Potential Application of Mixed Reality Technology in Orthopaedic Oncology

Abstract

In orthopaedic oncology, surgical planning and intraoperative execution errors may result in positive tumor resection margins that increase the risk of local recurrence and adversely affect patients' survival. Computer navigation and 3D-printed resection guides have been reported to address surgical inaccuracy by replicating the surgical plans in complex cases. However, limitations include surgeons' attention shift from the operative field to view the navigation monitor and expensive navigation facilities in computer navigation surgery. Practical concerns are lacking real-time visual feedback of preoperative images and the lead-time in manufacturing 3D-printed objects. Mixed Reality (MR) is a technology of merging real and virtual worlds to produce new environments with enhanced visualizations, where physical and digital objects coexist and allow users to interact with both in real-time. The unique MR features of enhanced medical images visualization and interaction with holograms allow surgeons real-time and on-demand medical information and remote assistance in their immediate working environment. Early application of MR technology has been reported in surgical procedures. Its role is unclear in orthopaedic oncology. This review aims to provide orthopaedic tumor surgeons with up-to-date knowledge of the emerging MR technology. The paper presents its essential features and clinical workflow, reviews the current literature and potential clinical applications, and discusses the limitations and future development in orthopaedic oncology. The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology. The MR head-mounted display and hand-free control may achieve clinical point-of-care inside or outside the operating room and improve service efficiency and patient safety. However, lacking an accurate hologram-to-patient matching, an MR platform dedicated to orthopaedic oncology, and clinical results may hinder its wide adoption. Industry-academic partnerships are essential to advance the technology with its clinical role determined through future clinical studies.

Development of metaverse for intelligent healthcare

“…The metaverse is the confluence of rapid and profound technical and sociological developments. It contains avatars that represent us and duplicate many objects around us such as medical imaging equipment, and has the potential to encompass many disciplines [62][63][64] . In addition to entertainment and social networking, metaverse applications include professional training, K-12 (from kindergarten to 12 years of basic education) and college education, supply chains, real estate marketing, and MeTAI as envisioned here.…”

Mixed Reality Improves 3D Visualization and Spatial Awareness of Bone Tumors for Surgical Planning in Orthopaedic Oncology: A Proof of Concept Study

“…With less cognitive load and improved ergonomics on wearing MR HMD, surgeons can stay focused on the patients and surgical tasks while keeping their hands free without losing the sterility of the surgical field in the operating room. 9 Therefore, MR technology addresses the limitations of attention shift in computer navigation 5 or absent real-time image feedback in 3D printed guides 22 for orthopaedic oncology. The various assistive tools may be complementary in improving surgical care but are not mutually exclusive in clinical applications, as each has its inherent strengths and weakness.…”

Revolutionizing Orthopedic Surgery: The Integration of Holographic Technology

“…Conceived by Dennis Gabor in 1948, holographic imaging has evolved significantly, providing real-time, three-dimensional visualizations of human anatomy, thereby aiding surgeons in complex procedures [ 1 ]. This technology enhances surgical precision through high-resolution, interactive representations of patient-specific anatomical structures, leading to more accurate planning and less invasive surgeries, crucial for better patient outcomes [ 2 , 3 ]. This integration signifies a paradigm shift in surgical practices, equipping surgeons to visualize bones, joints, and tissues in unprecedented detail and immersion, similar to moving from radiographs to 3D computed tomography (CT) scans but with the added benefits of interactivity and real-time manipulation.…”

“…Initially reliant on manual skills and basic tools, the field was revolutionized in the late 19th century with the advent of X-ray imaging, allowing non-invasive bone and joint visualization [ 5 ]. The 20th century saw further advancements with the introduction of CT and MRI, providing detailed cross-sectional views of the musculoskeletal system, thereby enhancing diagnostic accuracy and pre-operative planning [ 3 , 6 ]. A major transition occurred with the shift from conventional radiography to CT and MRI, offering more intricate musculoskeletal anatomy representations and moving toward a technology-assisted surgical approach [ 2 ].…”