The effect of augmented real-time image guidance on task workload during endoscopic sinus surgery.
BACKGROUND
Due to proximity to critical structures, the need for spatial awareness during endoscopic sinus surgery (ESS) is essential. We have developed an augmented, real-time image-guided surgery (ART-IGS) system that provides live navigational data and proximity alerts to the operating surgeon during ablation. We wished to test the hypothesis that task workload would be reduced when using this technology.


METHODS
A trial involved 8 otolaryngology residents and fellows performing ESS on cadaveric specimens; 1 side in a conventional method (control) and 1 side with ART-IGS. After computed tomography scanning, anatomical contouring, and registration of the head, a three-dimensional (3D) virtual endoscopic view, ablative tool tracking, and proximity alerts were enabled. Each subject completed ESS tasks and rated their workload during and after the exercise using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX). A questionnaire and open feedback interview were completed after the procedure.


RESULTS
There was a significant reduction in mental demand, temporal demand, effort, and frustration when using the ART-IGS system in comparison to the control (p < 0.02). Perceived performance was increased (p = 0.02). Most subjects agreed that the system was sufficiently accurate, caused minimal interruption, and increased confidence. Optical tracking line-of-sight issues were frequently cited as the main limitation early in the study; however, this was largely resolved.


CONCLUSIONS
ART-IGS reduces task workload for trainees performing ESS. Live navigation and alert zones may be a valuable intraoperative teaching aid.
Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Benjamin J
BJ
Dixon
Harley
H
Chan
Michael J
MJ
Daly
Allan D
AD
Vescan
Ian J
IJ
Witterick
Jonathan C
JC
Irish
D002102:Cadaver; D003199:Computer Systems / Q000706:statistics & numerical data; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013647:Task Performance and Analysis; D016526:Workload