Authors: (including presenting author): :
Li MLM (1), Wong KC(1), Lau HYA (2)
Affiliation: :
(1) Orthopaedics Oncology, Prince of Wales Hospital (2) 3D Printing Office, NTEC
Keyword 1: :
Mixed reality
Keyword 2: :
Orthopaedics
Introduction: :
In this era of rapid technological advancement, surgical techniques and instruments have evolved at a hastening pace. Patient's demands and expectations have also modulated from life saving aim alone to maintaining activities of daily living as well. Likewise in orthopaedics oncology, achieving margin free resections while maintaining the function of the limb is of paramount importance. Soft tissue tumors vary from benign to malignant, low grade to high grade. Challenges in management of these tumors exist in both pre-operative planning as well as execution. During pre-operative planning, CT and MRI are essential in providing information of the tumor as well as its relationship with surrounding structures. Conventionally, the surgeon is required to mentally integrate the 2D information into a 3D plan so as to formulate a tumor free resection margin. After planning the resection margin, it has to be accurately correlated onto the patient's body for accurate execution. This is highly mentally demanding especially for young developing surgeons as it demands a high cognitive load integrated with years of experience to have accurate planning, correlation and execution. As orthopedic tumor cases varies greatly from one another, it is hard for a young surgeon to quickly attain such levels of correlation and experience. Often, it would take years of training to build up such experience. Undoubtedly, this fast paced society rarely provides such extravagance for a surgeon to learn slowly. Mixed Reality thus here, plays an important role in bridging the gap. In the application of mixed reality, the tumor and its surrounding structure would first be marked on computer software. By the use of hardware device such as Hololens, the images would be projected in a 1:1 ratio onto the patient's body with accordance to the surface landmarks. After correlation, the surgeon would have a direct visualization between the 3D image as well as the patient's body allowing him to accurate mark the surgical incisions to attain a tumor free resection.
Objectives: :
The primary objective of this study is to evaluate the efficacy of Mixed Reality (MR) technology as a surgical planning tool in orthopaedic oncology, with a focus on its impact on the surgeon's cognitive process and spatial understanding prior to incision, bridging the preoperative planning gap. Second, it aims to assess whether the real-time, stereoscopic overlay of patient-specific 3D holograms onto a patient’s anatomy enhances a surgeon's spatial awareness of bone tumor location, orientation, and relationship to vital structures. Surgical parameters eg tumor resection margins, operative time and also surgeon's experience were also recorded.
Methodology: :
21 soft tissue sarcoma cases done with the aid of mixed reality were retrieved from 2023-2025. Surgical outcomes such as resection margins, recurrence and survival was documented. TIming of surgery was also recorded while experiences of surgeons were also registered.
Result & Outcome: :
Preliminary data has suggested that there was no decrease in quality of resection margins as compared to conventional methods. There was also no statistical difference in timing of surgery. Experience of surgeons were positive that confirmed the benefits of application of mixed reality in orthopaedic oncology surgeries.
