Supporting fibula free flap harvest with augmented reality: A proof‐of‐concept study

• Published in: The Laryngoscope Vol. 130; no. 5; pp. 1173 - 1179
• Main Authors: Pietruski, Piotr, Majak, Marcin, Świątek‐Najwer, Ewelina, Żuk, Magdalena, Popek, Michał, Jaworowski, Janusz, Mazurek, Maciej
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-05-2020; Wiley Subscription Services, Inc
• Subjects: Augmented reality; CAS; Computer assisted surgery; free fibula flap; image‐guided surgery; intraoperative navigation; Otolaryngology; Surgical techniques; image-guided surgery; free fibula flap; intraoperative navigation; computer-assisted surgery; Augmented reality
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.28090

Objective
To analyze a novel navigation system utilizing augmented reality (AR) as a supporting method for fibula free flap (FFF) harvest and fabrication.
Methods
A total of 126 simulated osteotomies supported with a cutting guide or one of two AR‐based intraoperative navigation modules—simple AR (sAR) or navigated AR (nAR)—were carried out on 18 identical models of the fibula (42 osteotomies per method). After fusing postoperative computed tomography scans of the operated fibulas with the virtual surgical plan based on preoperative images, the objective outcomes—angular deviations from the planned osteotomy trajectory (o) and deviations of control points marked on the trajectory (mm)—were determined.
Results
All analyzed methods provided similar accuracy of assisted osteotomies. The only significant difference referred to angular deviation in the sagittal plane, which was smaller after the cutting guide‐assisted procedures than after the application of sAR and nAR (4.1 ± 2.29 vs. 5.08 ± 3.64 degrees, P = 0.031 and 4.1 ± 2.29 vs. 4.97 ± 2.91, P = 0.002, respectively). Mean deviation of control points after the cutting guide‐assisted procedures was 2.76 ± 1.06 mm, as compared with 2.67 ± 1.09 mm for sAR and 2.95 ± 1.11 mm for nAR.
Conclusion
Our study demonstrated that both novel AR‐based methods provided similar accuracy of assisted harvesting and contouring of the FFF as the cutting guides. This fact, as well as the acceptability of the concept by clinicians, justify their further development and evaluation in preclinical settings.
Level of Evidence
NA
Laryngoscope, 130:1173–1179, 2020