Interactive Ecosystem for Surgical Training in a Realistic Mixed-Reality

Abstract

In many surgical procedures, surgeons rely on their general knowledge of anatomy and relatively crude measurements, which have inevitable uncertainties in locating internal anatomical targets. One example procedure that is frequently performed in neurosurgery is ventriculostomy (also called external ventricular drainage), where the surgeon inserts a catheter into the ventricle to drain cerebrospinal fluid (CSF). In this procedure, often performed bedside and therefore without image guidance, the surgeon makes measurements relative to cranial features to determine where to drill into the skull and then attempts to insert a catheter as perpendicular to the skull as possible. Although it is one of the most commonly performed neurosurgical procedures, about one quarter to one third of catheters are misplaced or require multiple attempts [19, 15], potentially resulting in brain injury and increasing healthcare costs [2]. We propose a portable navigation system, based on mixed reality (MR) on a head mounted display (HMD), specifcally HoloLens (Microsoft, Redmond, WA) to provide image guidance in less structured environments, such as at the patient bedside in an intensive care unit, where it is not practical to install a separate tracking camera, computer, and display. Furthermore, the mixed reality guidance can provide an ergonomic benefit because it is visually overlaid in the surgeon's field of view, thus avoiding the need to look away from the patient to observe an external monitor.