title: A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.
abstract: OBJECTIVE
  To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.
  
  
  METHODS
  In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.
  
  
  RESULTS
  The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.
  
  
  CONCLUSIONS
  The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.affiliation: Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yang
authors.affiliation: Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Electronics, Beijing Institute of Technology, Beijing, China.
authors.forename: Yakui
authors.initials: Y
authors.lastname: Chu
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Wenbo
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Xue
authors.affiliation: Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Liang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
mesh_terms: D002102:Cadaver; D003198:Computer Simulation; D004724:Endoscopy / Q000379:methods; D005240:Feasibility Studies; D006257:Head / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D019635:Neurosurgical Procedures / Q000379:methods; D009666:Nose / Q000601:surgery; D061646:Operative Time; D010256:Paranasal Sinuses / Q000601:surgery*; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D019291:Skull Base / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*