The introduction of image-guided surgical navigation (IGSN) has greatly benefited technically demanding surgical procedures by providing real-time support and guidance to the surgeon during surgery. To develop effective IGSN, a careful selection of the information provided to the surgeon is needed. However, identifying optimal feedback modalities is challenging due to the broad array of available options. To address this problem, we have developed an open-source library that facilitates the development of multimodal navigation systems in a wide range of surgical procedures relying on medical imaging data. To provide guidance, our system calculates the minimum distance between the surgical instrument and the anatomy and then presents this information to the user through different mechanisms. The real-time performance of our approach is achieved by calculating Signed Distance Fields at initialization from segmented anatomical volumes. Using this framework, we developed a multimodal surgical navigation system to help surgeons navigate anatomical variability in a skull-base surgery simulation environment. Three different feedback modalities were explored: visual, auditory, and haptic. To evaluate the proposed system, a pilot user study was conducted in which four clinicians performed mastoidectomy procedures with and without guidance. Each condition was assessed using objective performance and subjective workload metrics. This pilot user study showed improvements in procedural safety without additional time or workload. These results demonstrate our pipeline's successful use case in the context of mastoidectomy.

翻译：图像引导手术导航（IGSN）的引入，通过为外科医生提供术中实时支持与引导，极大地惠及了技术难度较高的外科手术。要开发有效的IGSN，需审慎选择提供给外科医生的信息。然而，由于现有反馈方式种类繁多，确定最优的反馈模态极具挑战性。为解决此问题，我们开发了一个开源库，该库有助于在依赖医学影像数据的各类外科手术中构建多模态导航系统。为实现引导功能，系统计算出手术器械与解剖结构之间的最小距离，并通过不同机制将此信息呈现给用户。通过初始化时从分割解剖容积中计算有符号距离场，我们实现了方法的实时性能。借助该框架，我们开发了一个多模态手术导航系统，以帮助外科医生在颅底手术模拟环境中应对解剖变异。研究探索了三种不同的反馈模态：视觉、听觉和触觉。为评估所提系统，我们开展了一项初步用户研究，由四位临床医生在有无引导的条件下执行乳突切除术。每种实验条件均通过客观手术表现与主观工作负荷指标进行评估。该初步研究显示，在未增加额外时间或工作负荷的情况下，手术安全性得到提升。这些结果证明了我们流程在乳突切除术中的成功应用案例。