Studying the Implications of Augmented Reality for Teamwork in Open Liver Surgery

Paper Title

Studying the Implications of Augmented Reality for Teamwork in Open Liver Surgery

Publication Info

• Topic area: Augmented reality applications in surgical teamwork and performance.
• Keywords: Augmented reality, liver surgery, teamwork, surgical collaboration, 3D reconstruction, head-mounted display, medical imaging, hepatectomy, surgical workflow, intraoperative guidance.

Background and Problem

• Problem / challenge: Current methods for integrating 3D reconstructions into surgical workflows are unclear, with limited understanding of how display modalities affect teamwork and communication in open liver surgery.
• Significance: Effective integration of 3D imaging tools could improve surgical precision and team collaboration, addressing challenges in complex procedures like hepatectomy.
• Motivation and related work: Prior research has demonstrated the benefits of 3D imaging for anatomical understanding and surgical planning but has largely focused on individual performance metrics rather than team dynamics. This study addresses the gap by exploring the impact of display modalities on collaboration and communication within surgical teams.

Solution

• Proposed approach: Comparative evaluation of four display modalities for 3D reconstructions in a simulated open liver surgery setting, focusing on teamwork and surgical performance.
• Novelty:
  1. Analysis of private versus shared display modalities and their impact on collaboration.
  2. Experimental evaluation of augmented reality (AR) head-mounted displays (HMDs) for intraoperative guidance.
  3. Identification of design recommendations for AR systems in surgical contexts.
• Procedure and key techniques:
  • Conducted user research through interviews and observations to understand current surgical workflows.
  • Designed a simulated hepatectomy task focusing on marking incision lines.
  • Compared four conditions: shared 2D monitor (Non-AR), shared AR on 2D monitor, private AR-HMD for main surgeon with 2D monitor for assistant, and private AR-HMDs for both surgeons.
  • Collected quantitative (task completion time, incision accuracy) and subjective data (NASA-TLX, SUS, interviews).

Results

• Concrete findings:
  • No significant differences in task completion time or incision line accuracy across conditions.
  • AR-HMDs were preferred for their depth perception and spatial understanding.
  • Shared visual perspectives were critical for effective collaboration.
• Advantage over baselines:
  • AR-HMDs improved spatial reasoning compared to 2D monitors but introduced challenges in communication when perspectives were not shared.
• Experiments / evaluation:
  • 32 trials with 16 surgeons in pairs, using simulated liver models and various display setups.
  • Data collected included task metrics, subjective questionnaires, video recordings, and interviews.
• Limitations and future work:
  • Small sample size limits generalizability.
  • Rigid 3D models and single-patient data restrict clinical applicability.
  • Future work should explore deformable models, larger teams, and integration with real-time imaging techniques like ultrasonography.

Summary

This study investigated the impact of augmented reality (AR) and 3D reconstruction display modalities on teamwork and performance in open liver surgery. While AR-HMDs enhanced depth perception and spatial understanding, shared visual perspectives were essential for effective collaboration. The findings highlight a trade-off between individual anatomical analysis and team communication. Key contributions include insights into surgical workflows, experimental evidence on display modality impacts, and design recommendations for AR systems, such as gesture-based interaction, zoom functionality, and deformable models. These results provide a foundation for developing AR-supported systems that balance individual and collaborative needs in complex surgical procedures.