DataSheet_2_Augmented Reality and Intraoperative Navigation in Sinonasal Malignancies: A Preclinical Study.zip

ObjectiveTo report the first use of a novel projected augmented reality (AR) system in open sinonasal tumor resections in preclinical models and to compare the AR approach with an advanced intraoperative navigation (IN) system.
MethodsFour tumor models were created. Five head and neck surgeons participated in the study performing virtual osteotomies. Unguided, AR, IN, and AR + IN simulations were performed. Statistical comparisons between approaches were obtained. Intratumoral cut rate was the main outcome. The groups were also compared in terms of percentage of intratumoral, close, adequate, and excessive distances from the tumor. Information on a wearable gaze tracker headset and NASA Task Load Index questionnaire results were analyzed as well.
ResultsA total of 335 cuts were simulated. Intratumoral cuts were observed in 20.7%, 9.4%, 1.2,% and 0% of the unguided, AR, IN, and AR + IN simulations, respectively (p < 0.0001). The AR was superior than the unguided approach in univariate and multivariate models. The percentage of time looking at the screen during the procedures was 55.5% for the unguided approaches and 0%, 78.5%, and 61.8% in AR, IN, and AR + IN, respectively (p < 0.001). The combined approach significantly reduced the screen time compared with the IN procedure alone.
ConclusionWe reported the use of a novel AR system for oncological resections in open sinonasal approaches, with improved margin delineation compared with unguided techniques. AR improved the gaze-toggling drawback of IN. Further refinements of the AR system are needed before translating our experience to clinical practice.

研究目的：报告首次将新型投影式增强现实（AR）系统应用于临床前模型的开放性鼻鼻窦肿瘤切除术，并将该AR术式与先进的术中导航（IN）系统进行对比。
研究方法：本研究构建了4种肿瘤模型，5名头颈外科医师参与研究并完成虚拟截骨操作，分别开展无引导、AR、IN以及AR+IN联合模拟操作，对各术式进行统计学比较。本研究的主要结局指标为瘤内切口率，同时对比各组术式中瘤内、紧邻肿瘤、距离适宜以及过度切割的占比情况，此外还分析了可穿戴眼动追踪头显的数据以及美国国家航空航天局任务负荷指数（NASA Task Load Index）问卷结果。
研究结果：共计完成335次模拟切割操作。无引导组、AR组、IN组以及AR+IN联合组的模拟操作中，瘤内切口占比分别为20.7%、9.4%、1.2%和0%（p < 0.0001）。单因素与多因素模型分析均显示，AR术式优于无引导术式。术中注视屏幕的时间占比方面，无引导组为55.5%，AR组、IN组与AR+IN联合组分别为0%、78.5%和61.8%（p < 0.001）。与单独使用IN术式相比，联合术式可显著缩短屏幕注视时间。
研究结论：本研究报道了新型AR系统在开放性鼻鼻窦肿瘤切除术中的应用，相较于无引导技术，该系统可提升肿瘤切缘的勾画精度，同时改善了IN系统存在的眼动切换弊端。在将本研究成果转化为临床应用前，仍需对该AR系统进行进一步优化。