title: Augmented reality in gynecologic surgery: evaluation of potential benefits for myomectomy in an experimental uterine model.
abstract: Augmented Reality (AR) is a technology that can allow a surgeon to see subsurface structures. This works by overlaying information from another modality, such as MRI and fusing it in real time with the endoscopic images. AR has never been developed for a very mobile organ like the uterus and has never been performed for gynecology. Myomas are not always easy to localize in laparoscopic surgery when they do not significantly change the surface of the uterus, or are at multiple locations.
  
  
  
  To study the accuracy of myoma localization using a new AR system compared to MRI-only localization.
  
  
  
  Ten residents were asked to localize six myomas (on a uterine model into a laparoscopic box) when either using AR or in conditions that simulate a standard method (only the MRI was available). Myomas were randomly divided in two groups: the control group (MRI only, AR not activated) and the AR group (AR activated). Software was used to automatically measure the distance between the point of contact on the uterine surface and the myoma. We compared these distances to the true shortest distance to obtain accuracy measures. The time taken to perform the task was measured, and an assessment of the complexity was performed.
  
  
  
  The mean accuracy in the control group was 16.80 mm [0.1-52.2] versus 0.64 mm [0.01-4.71] with AR. In the control group, the mean time to perform the task was 18.68 [6.4-47.1] s compared to 19.6 [3.9-77.5] s with AR. The mean score of difficulty (evaluated for each myoma) was 2.36 [1-4] versus 0.87 [0-4], respectively, for the control and the AR group.
  
  
  
  We developed an AR system for a very mobile organ. This is the first user study to quantitatively evaluate an AR system for improving a surgical task. In our model, AR improves localization accuracy.
authors.affiliation: Department of Gynecological Surgery, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63000, Clermont-Ferrand, France. nicolas.bourdel@gmail.com.|Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France. nicolas.bourdel@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.affiliation: Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Toby
authors.initials: T
authors.lastname: Collins
authors.affiliation: Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pizarro
authors.affiliation: Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Bartoli
authors.affiliation: Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.|Department of Radiology, CHU Clermont Ferrand, 1 Place Lucie Aubrac, Clermont-Ferrand, France.
authors.forename: David
authors.initials: D
authors.lastname: Da Ines
authors.affiliation: Biostatistics Unit, Department of Clinical Research and Innovation, CHU Clermont Ferrand, 63000, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Perreira
authors.affiliation: Department of Gynecological Surgery, CHU Clermont Ferrand, 1 Place Lucie Aubrac, 63000, Clermont-Ferrand, France.|Faculté de Médecine, ALCoV-ISIT (UMR6284 CNRS / Université d'Auvergne), 28 Place Henri Dunant, 63000, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006176:Gynecology / Q000193:education; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008953:Models, Anatomic; D012984:Software; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014584:User-Computer Interface; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Augmented Reality; Gynecologic surgery; Laparoscopy; MRI; Myomectomy