Ann Surg Treat Res.  2018 Dec;95(6):297-302. 10.4174/astr.2018.95.6.297.

Preliminary study on application of augmented reality visualization in robotic thyroid surgery

• Lee D
• Kong HJ
• Kim D
• Yi JW
• Chai YJ
• Lee KE
• Kim HC

• KMID: 2426760
• DOI: http://doi.org/10.4174/astr.2018.95.6.297

Abstract

PURPOSE
Increased robotic surgery is attended by increased reports of complications, largely due to limited operative view and lack of tactile sense. These kinds of obstacles, which seldom occur in open surgery, are challenging for beginner surgeons. To enhance robotic surgery safety, we created an augmented reality (AR) model of the organs around the thyroid glands, and tested the AR model applicability in robotic thyroidectomy.
METHODS
We created AR images of the thyroid gland, common carotid arteries, trachea, and esophagus using preoperative CT images of a thyroid carcinoma patient. For a preliminary test, we overlaid the AR images on a 3-dimensional printed model at five different angles and evaluated its accuracy using Dice similarity coefficient. We then overlaid the AR images on the real-time operative images during robotic thyroidectomy.
RESULTS
The Dice similarity coefficients ranged from 0.984 to 0.9908, and the mean of the five different angles was 0.987. During the entire process of robotic thyroidectomy, the AR images were successfully overlaid on the real-time operative images using manual registration.
CONCLUSION
We successfully demonstrated the use of AR on the operative field during robotic thyroidectomy. Although there are currently limitations, the use of AR in robotic surgery will become more practical as the technology advances and may contribute to the enhancement of surgical safety.

Keyword

Thyroidectomy; Thyroid neoplasms; Augmented reality; Robotic surgical procedures; Computed-assisted surgery

MeSH Terms

Carotid Artery, Common
Esophagus
Humans
Robotic Surgical Procedures
Surgeons
Thyroid Gland*
Thyroid Neoplasms
Thyroidectomy
Trachea

Figure

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  Fig. 1 Total procedures for constructing 3-dimensional (3D) models: segmentation, 3D reconstruction, and creating 3D printer model and 3D computer-aided design (CAD) model.

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  Fig. 2 3-Dimensional (3D) printer model and 3D computer-aided design model for evaluation of registration performance using Dice similarity coefficient at different angles. Rectangular coordinate system is displayed center (x-, y-, z-axis are demonstrated in red, blue, green). (A) 3D printer model at 60°, (B) 3D printer model at 90°, (C) image registration at 60°, and (D) image registration at 90°.

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  Fig. 3 3-Dimensional computer-aided design model registration on surgical image during robotic thyroidectomy. (A) Before registration, (B) registration on the muscles, (C) tracheal exposure, (D) registration on the trachea, (E) left thyroid lobectomy, and (F) registration on the trachea, augmented reality image of left thyroid is turned off.

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