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 surgical information and the medium to present this information to the surgeon is needed. However, this is not a trivial task 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）的引入为技术难度较高的外科手术提供了术中实时支持与引导，从而带来了显著益处。要开发有效的IGSN系统，需要精心选择手术信息及向外科医生呈现该信息的媒介。然而，由于可选方案众多，这并非易事。为解决此问题，我们开发了一个开源库，该库能够基于医学影像数据，为广泛外科手术中多模态导航系统的开发提供支持。为实现引导功能，本系统计算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。我们通过在初始化阶段从分割后的解剖体数据中计算符号距离场，实现了方法的实时性能。利用此框架，我们开发了一套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结构变异。本研究探索了三种不同的反馈模式：视觉、听觉与触觉。为评估所提出的系统，我们开展了一项初步用户研究，由四位临床医师分别在有无引导的情况下实施乳突切除术。每种条件均通过客观性能指标与主观工作负荷指标进行评估。该初步研究表明，在未增加时间或工作负荷的前提下，手术安全性得到了提升。这些结果证明了我们的流程在乳突切除术场景中的成功应用。