Gelderse Vallei is to deploy Augmented Reality (AR) when placing shoulder replacements. The initiative is part of a project to assess the deployability of AR technology in operations. It is a pilot study involving three Dutch hospitals, including Gelderse Vallei.
Augmented Reality is a technology in which a digital layer is placed on top of the physical world. Users wear AR glasses. Unlike VR glasses, with AR glasses users see not only a digital world, but also the real world. Among other things, this enables the projection of information onto physical objects.
Projecting shoulder joint onto patient's shoulder
Orthopaedic surgeon Alexander Poublon of Gelderse Vallei will operate using glasses. This will project a digital AR image of the shoulder joint onto the patient's shoulder. This is a study, which aims to assess the feasibility of AR.
Surgery using AR requires different preparation than regular surgery. Poublon: "As so often with innovation, I expect it to take more time in the beginning, but to save us a lot of time afterwards. I think we are going to see great results."
Deployment for various prosthetics explored
The research is taking place in three Dutch hospitals, of which Gelderse Vallei is one. Part of it involves operations in which various prostheses are placed. These operations are performed by orthopaedic surgeons who have extensive experience in placing the specific prosthesis. That includes Poublon, who has already placed more than 100 of these shoulder prostheses.
As part of the study, Poublon will operate three times using AR during the months of December and January. During these operations, the surgeon wears glasses, which project the AR image onto the patient's shoulder. Poublon explains, "During surgery, you have minimal visibility of the shoulder joint, because we only want and can make a limited opening. I only see a little bit of blood and a very small piece of the glenoid (the socket of the shoulder) and not the whole shoulder blade. This means that during surgery I have to rely entirely on the preparations and the image of the CT scan taken beforehand. With these AR glasses, I can 'see' the whole shoulder joint on the spot, as it is projected onto the patient's shoulder. This is expected to help me determine the position of the prosthesis even better during surgery, making the placement even more accurate."
Previous experiences with the AR glasses were pleasant, says Poublon. "It was very nice. You can do all kinds of things with it, you can walk around the image, enlarge it, reduce it and omit parts (like screws). Moreover, you can still adjust the image during surgery if necessary."
Anatomy Projector
This is not the first time hospitals have used AR technology to project information onto a patient's body. An earlier example is Anatomy Projector, an AR device developed by Radboudumc. Anatomy Projector projects information onto the patient's body, such as blood vessels and lymph nodes. The AR tool has been used in breast reconstructions, among other cases.
The information displayed by Anatomy Projector comes from a CT scan, based on which a 3D plan is created. The patient is then given markers applied to the skin, after which the AR tool displays the 3D plan on the body during surgery
Holograms based on brain scans
UMC Utrecht has also been working on the deployment of AR technology during operations for several years. This involves brain operations, where it wants to support surgeons with automatically generated holograms based on brain scans. A hologram is a three-dimensional image that can be displayed, for example, using 3D glasses, tablet or smartphone. https://www.umcutrecht.nl/nieuws/hologrammen-maken-hersenoperaties-veiliger
A third example is research by Prof Theo Ruers with funding from the KWF into the use of AR in operations on colon cancer patients with liver metastases. Here, AR technology converts information from pre-made scans into 3D models, which it projects onto the surgery screen as an additional layer of information during surgery. This allows surgeons to see exactly which anatomical structures they are cutting into.
Author: Wouter Hoeffnagel
Image: Fernando Zhiminaicela via Pixabay
