How augmented reality can improve surgical accuracy and patient outcomes

The use of computer-assisted navigation and robotics within surgery has exploded in recent years. Augmented reality technologies can now improve surgical accuracy and offer more complete data all within the surgeon's visual field, which can improve patient safety and outcomes while reducing postoperative complications.

During a December Becker's Hospital Review webinar sponsored by Augmedics, neurosurgeon John H. Shin, MD, Director of Spine Oncology and Spinal Deformity Surgery at the Massachusetts General Hospital in Boston, shared his experience using augmented reality tools in spinal fusion surgeries.

Four key insights were: 

  1. Accuracy of placing instrumentation in spinal fusion surgeries is critical. "Optimizing the accuracy of instrumentation placement is very important to minimize complications that are, in general, avoidable," Dr. Shin said. "Safety is important; we're working to optimize outcomes for our patients."

  2. Although computer-assisted navigation tools such as robotics can be effective, they all have limitations. Over the years, a continuum of computer-assisted navigation tools has been developed. Dr. Shin explained that the question now is, "Which technologies offer the optimal workflow and the best value for the patient, surgeon and hospital?"

    Although the literature increasingly shows that robotic-assisted pedicle screw placement is effective in accuracy of screw placement, incorporating such technology may have acquisition, implementation, and financial considerations in a practice setting. "With conventional navigation and robotic platforms, a consistent limitation for the surgeon is having to take our eyes away from the field," Dr. Shin said. "This can have drawbacks, especially when passing instruments around neural and vascular structures where millimeters can make a difference. It is exciting to see how continued development will account for such limitations. " Other drawbacks include expense, obsolescence, limited scalability, staff training requirements and contamination risks.

  3. Augmented reality overcomes limitations of other computer-assisted navigation tools. With augmented reality, surgeons can keep their eyes and hands in the visualization field using real-time tracking to place instrumentation. A study published in JNS Spine demonstrated screw placement accuracy. "In terms of grading the accuracy of the screws, you can see that 98 percent of more than 200 screws placed earned a grade A or B rating," Dr. Shin said.

    "As a spine surgeon, I am thinking about how I can incorporate enabling technologies to maximize accuracy," Dr. Shin said. "Augmented reality brings a number of data points into our surgical field, so I can optimize my efficiency and accuracy in surgery. As surgeons, we are constantly processing and interpreting numerous data points, whether communicating with anesthesia, interpreting vital signs, performing surgery, or making sure we have everything we need to ensure the best possible outcome. Augmented reality helps bring CT images of the anatomy and surgical plan into my visual field to implement the plan that I am trying to execute."

    Other benefits are that augmented reality requires a lower initial capital outlay, can work with any instrumentation system and takes up little physical space.

  4. Augmented reality holds promise for the future of spine surgery. As augmented reality technology continues to develop, Dr. Shin is excited about future possibilities. "I would like to see the technology be able to give us real-time feedback incorporating changes made during surgery without the need to re-image or re-calibrate instruments. I am particularly interested in using this technology for other aspects of surgery other than instrumentation placement such as planning osteotomies and tumor resections," he said. "In spine surgery, there are a lot of potential land mines, and complications can be high. I think augmented reality will be incredibly important in moving the field forward."

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