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. \hi{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）的引入通过为外科医生在手术过程中提供实时支持和指导，极大地惠及了技术要求高的手术流程。为开发有效的IGSN，需要精心选择手术信息以及向外科医生呈现这些信息的媒介。然而，由于可用选项广泛，这并非易事。为解决这一问题，我们开发了一个开源库，该库便于在依赖医学成像数据的多种手术流程中开发多模态导航系统。为提供指导，我们的系统计算手术器械与解剖结构之间的最小距离，然后通过不同机制将这些信息呈现给用户。通过从分割后的解剖体积在初始化时计算符号距离场，实现了本方法的实时性能。利用这一框架，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仿真环境中导航解剖变异。探索了三种不同的反馈模态：视觉、听觉和触觉。为评估所提出的系统，进行了一项初步用户研究，其中四位临床医生在有和无引导的条件下执行乳突切除术。每种条件均使用客观性能和主观工作量指标进行评估。这项初步用户研究显示，在未增加额外时间或工作量的情况下，手术安全性得到改善。这些结果证明了我们的流程在乳突切除术中的成功应用案例。