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      Optimization of virtual and real registration technology based on augmented reality in a surgical navigation system

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          Abstract

          Background

          The traditional navigation interface was intended only for two-dimensional observation by doctors; thus, this interface does not display the total spatial information for the lesion area. Surgical navigation systems have become essential tools that enable for doctors to accurately and safely perform complex operations. The image navigation interface is separated from the operating area, and the doctor needs to switch the field of vision between the screen and the patient’s lesion area. In this paper, augmented reality (AR) technology was applied to spinal surgery to provide more intuitive information to surgeons. The accuracy of virtual and real registration was improved via research on AR technology. During the operation, the doctor could observe the AR image and the true shape of the internal spine through the skin.

          Methods

          To improve the accuracy of virtual and real registration, a virtual and real registration technique based on an improved identification method and robot-assisted method was proposed. The experimental method was optimized by using the improved identification method. X-ray images were used to verify the effectiveness of the puncture performed by the robot.

          Results

          The final experimental results show that the average accuracy of the virtual and real registration based on the general identification method was 9.73 ± 0.46 mm (range 8.90–10.23 mm). The average accuracy of the virtual and real registration based on the improved identification method was 3.54 ± 0.13 mm (range 3.36–3.73 mm). Compared with the virtual and real registration based on the general identification method, the accuracy was improved by approximately 65%. The highest accuracy of the virtual and real registration based on the robot-assisted method was 2.39 mm. The accuracy was improved by approximately 28.5% based on the improved identification method.

          Conclusion

          The experimental results show that the two optimized methods are highly very effective. The proposed AR navigation system has high accuracy and stability. This system may have value in future spinal surgeries.

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          Most cited references57

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          Minimally Invasive Robotic Versus Open Fluoroscopic-guided Spinal Instrumented Fusions: A Randomized Controlled Trial.

          A prospective randomized clinical trial.
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            Perioperative course and accuracy of screw positioning in conventional, open robotic-guided and percutaneous robotic-guided, pedicle screw placement

            Robotic-guided and percutaneous pedicle screw placement are emerging technologies. We here report a retrospective cohort analysis comparing conventional open to open robotic-guided and percutaneous robotic-guided pedicle screw placement. 112 patient records and CT scans were analyzed concerning the intraoperative and perioperative course. 35 patients underwent percutaneous, 20 open robotic-guided and 57 open conventional pedicle screw placement. 94.5% of robot-assisted and 91.4% of conventionally placed screws were found to be accurate. Percutaneous robotic and open robotic-guided subgroups did not differ obviously. Average X-ray exposure per screw was 34 s in robotic-guided compared to 77 s in conventional cases. Subgroup analysis indicates that percutaneously operated patients required less opioids, had a shorter hospitalization and lower rate of adverse events in the perioperative period. The use of robotic guidance significantly increased accuracy of screw positioning while reducing the X-ray exposure. Patients seem to have a better perioperative course following percutaneous procedures.
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              Spinal robotics: current applications and future perspectives.

              Even though robotic technology holds great potential for performing spinal surgery and advancing neurosurgical techniques, it is of utmost importance to establish its practicality and to demonstrate better clinical outcomes compared with traditional techniques, especially in the current cost-effective era. Several systems have proved to be safe and reliable in the execution of tasks on a routine basis, are commercially available, and are used for specific indications in spine surgery. However, workflow, usability, interdisciplinary setups, efficacy, and cost-effectiveness have to be proven prospectively. This article includes a short description of robotic structures and workflow, followed by preliminary results of a randomized prospective study comparing conventional free-hand techniques with routine spine navigation and robotic-assisted procedures. Additionally, we present cases performed with a spinal robotic device, assessing not only the accuracy of the robotic-assisted procedure but also other factors (eg, minimal invasiveness, radiation dosage, and learning curves). Currently, the use of robotics in spinal surgery greatly enhances the application of minimally invasive procedures by increasing accuracy and reducing radiation exposure for patients and surgeons compared with standard procedures. Second-generation hardware and software upgrades of existing devices will enhance workflow and intraoperative setup. As more studies are published in this field, robot-assisted therapies will gain wider acceptance in the near future.
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                Author and article information

                Contributors
                clksuda2018@163.com
                zhangfengfeng@suda.edu.cn
                zhanwei@suda.edu.cn
                Journal
                Biomed Eng Online
                Biomed Eng Online
                BioMedical Engineering OnLine
                BioMed Central (London )
                1475-925X
                8 January 2020
                8 January 2020
                2020
                : 19
                : 1
                Affiliations
                [1 ]ISNI 0000 0001 0198 0694, GRID grid.263761.7, School of Mechanical and Electrical Engineering, , Soochow University, ; Suzhou, 215006 China
                [2 ]ISNI 0000 0001 0198 0694, GRID grid.263761.7, Collaborative Innovation Center of Suzhou Nano Science and Technology, , Soochow University, ; Suzhou, 215123 China
                [3 ]GRID grid.429222.d, Department of Radiation Oncology, , The First Affiliated Hospital of Soochow University, ; Suzhou, China
                Article
                745
                10.1186/s12938-019-0745-z
                6950982
                31915014
                d4218aa3-43a1-4f18-bc6e-3a080bb7161e
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 April 2019
                : 30 December 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Biomedical engineering
                augmented reality,virtual and real registration,surgical navigation,robot,improved identification method

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