[Team training and assessment in mixed reality-based simulated operating room : Current state of research in the field of simulation in spine surgery exemplified by the ATMEOS project]. / Teamtraining und Assessment im Mixed-reality-basierten simulierten OP : Aktueller Stand der Forschung im Bereich Simulation in der Wirbelsäulenchirurgie am Beispiel des Projekts ATMEOS.

Surgical simulators are being increasingly used as an attractive alternative to clinical training in addition to conventional animal models and human specimens. Typically, surgical simulation technology is designed for the purpose of teaching technical surgical skills (so-called task trainers). Simulator training in surgery is therefore in general limited to the individual training of the surgeon and disregards the participation of the rest of the surgical team. The objective of the project Assessment and Training of Medical Experts based on Objective Standards (ATMEOS) is to develop an immersive simulated operating room environment that enables the training and assessment of multidisciplinary surgical teams under various conditions. Using a mixed reality approach, a synthetic patient model, real surgical instruments and radiation-free virtual X­ray imaging are combined into a simulation of spinal surgery. In previous research studies, the concept was evaluated in terms of realism, plausibility and immersiveness. In the current research, assessment measurements for technical and non-technical skills are developed and evaluated. The aim is to observe multidisciplinary surgical teams in the simulated operating room during minimally invasive spinal surgery and objectively assess the performance of the individual team members and the entire team. Moreover, the effectiveness of training methods and surgical techniques or success critical factors, e. g. management of crisis situations, can be captured and objectively assessed in the controlled environment.

[3D augmented reality visualization for navigated osteosynthesis of pelvic fractures]. / "3D-augmented-reality"-Visualisierung für die navigierte Osteosynthese von Beckenfrakturen.

BACKGROUND: Despite great advances in the development of hardware and software components, surgical navigation systems have only seen limited use in current clinical settings due to their reported complexity, difficulty of integration into clinical workflows and questionable advantages over traditional imaging modalities. OBJECTIVES: Development of augmented reality (AR) visualization for surgical navigation without the need for infrared (IR) tracking markers and comparison of the navigation system to conventional imaging. MATERIAL AND METHODS: Novel navigation system combining a cone beam computed tomography (CBCT) capable C­arm with a red-green-blue depth (RGBD) camera. Testing of the device by Kirschner wire (K-wire) placement in phantoms and evaluation of the necessary operating time, number of fluoroscopic images and overall radiation dose were compared to conventional x­ray imaging. RESULTS: We found a significant reduction of the required time, number of fluoroscopic images and overall radiation dose in 3D AR navigation in comparison to x­ray imaging. CONCLUSION: Our AR navigation using RGBD cameras offers a flexible and intuitive visualization of the operating field for the navigated osteosynthesis without IR tracking markers, enabling surgeons to complete operations quicker and with a lower radiation exposure to the patient and surgical staff.

[Intraoperative augmented reality visualization. Current state of development and initial experiences with the CamC]. / Intraoperative "Augmented-reality-Visualisierung". Aktueller Stand der Entwicklung und erste Erfahrungen mit dem CamC.

The intraoperative application of augmented reality (AR) has so far mainly taken place in the field of endoscopy. Here, the camera image of the endoscope was augmented by computer graphics derived mostly from preoperative imaging. Due to the complex setup and operation of the devices, they have not yet become part of routine clinical practice. The Camera Augmented Mobile C-arm (CamC) that extends a classic C-arm by a video camera and mirror construction is characterized by its uncomplicated handling. It combines its video live stream geometrically correct with the acquired X-ray. The clinical application of the device in 43 cases showed the strengths of the device in positioning for X-ray acquisition, incision placement, K-wire placement, and instrument guidance. With its new function and the easy integration into the OR workflow of any procedure that requires X-ray imaging, the CamC has the potential to become the first widely used AR technology for orthopedic and trauma surgery.