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A U G M E N T E D A N D V I R T U A L
R E A L I T Y I N P L A S T I C S U R G E R Y
Jonathan Kanevsky, MD
Mirko Gilardino, MD
Samuel Lin, MD
O U T L I N E
DEVICE DEMO
REALITY SPECTRUM
AR VR HARDWARE
AR VR APPLICATIONS
Franz Robaud – 1812-Battle of Borodino
1838: Charles Wheatstone
Motronheilig.com
Motronheilig.com
S P E C T R U M O F R E A L I T Y
Motronheilig.com
W H A T I S M I X E D R E A L I T Y ?
MR devices combine input from
multiple sensors in a wearable
platform
An on-board computer integrates
this information between the
device, the Internet, and the
outside world
The processed data is then
relayed to the user through a
visual display
W H A T I S V I R T U A L R E A L I T Y ?
W H A T I S V I R T U A L R E A L I T Y ?
W H A T I S A U G M E N T E D R E A L I T Y ?
• Spatial AR
• Hand Held
• Virtual Retina Display
• Contact Lens
• Head Mounted Display
W H A T I S A U G M E N T E D R E A L I T Y ?
Spatial Augmented Reality
W H A T I S A U G M E N T E D R E A L I T Y ?
Hand Held AR
W H A T I S A U G M E N T E D R E A L I T Y ?
Contact lens AR
http://www.extremetech.com/computing/126043-us-military-developing-multi-
focus-augmented-reality-contact-lenses
W H A T I S A U G M E N T E D R E A L I T Y ?
Virtual Retina Display
http://www.extremetech.com/computing/126043-us-military-developing-multi-
focus-augmented-reality-contact-lenses
W H A T I S A U G M E N T E D R E A L I T Y ?
www.dailymail.co.ukwww.dailymail.co.uk
Head Mounted Display
Google glass
Meta
H O L O L E N S
M I C R O S O F T
H O L O L E N S
M I C R O S O F T
A P P L I C A T I O N S I N P L A S T I C S U R G E R Y
Voice activated head-mounted camera optimal for hands free
recording form surgeon POV
Generate teaching libraries for plastic surgery eduction or record
resident technique
S U R G I C A L E D U C A T I O N :
www.ucsf.edu
Gaster and Lin, 2014
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
Augmented reality
display for:
- Diagrams
- Anatomical markings
- -AI applications
S U R G I C A L E D U C A T I O N :
Gaster , Lin, Kanevsky, Corban 2015
S U R G I C A L E D U C A T I O N :
Ma M, Fallavollita P, Seelbach I, et al. Personalized augmented reality for
anatomy education. Clinical anatomy (New York, N.Y.). 2016;29(4):446-453
S U R G I C A L E D U C A T I O N :
S U R G I C A L E D U C A T I O N :
S U R G I C A L E D U C A T I O N :
Transmit visual information for diagnosis and surgical planning
Trainees can call a senior surgeon to discuss a diagnosis
Virtual assistance during procedures with other surgeons in HUD
T E L E M E D I C I N E :
internetmedicine.com
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
http://1.bp.blogspot.com/-mVbtvRKhCJQ/UpKIR3hlw-
I/AAAAAAAAHgk/sNRLYQ0n4SI/s1600/VIPAAR_Google_Glass_Virtual_Surgeon.jpg
T E L E M E D I C I N E :
D A T A O V E R L A Y A N D D O C U M E N T A T I O N :
internetmedicine.com
Accessing patient information:
CT scans, MRIs, X-rays, patient
notes, labs or vital signs all while
remaining sterile in the operating
room.
Generating new notes:
OR dictations with embedded video
during surgery
Peri-operative utility:
Pre-operative markings, Post-
operative photos
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
C O N S U L T A T I O N :
http://www.illusioimaging.com/
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
P E R I O - O P E R A T I V E :
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
P A T I E N T C A R E :
internetmedicine.com
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
P A T I E N T C A R E :
internetmedicine.com
Perioperative Pain and Anxiety
P L A S T I C S U R G E R Y
A P P L I C A T I O N S
G A T E C O N T R O L
T H E O R Y
L I M I T A T I O N S
Two broad areas for which AR devices can be used to interface with the EMR:
• HIPAA compliance
• Distraction of Surgeon – Delayed
response time an decreased
awareness
• Cost effective innovation
T H E N E X T S T E P
Two broad areas for which AR devices can be used to interface with the EMR:
Adoption by the surgical community is a major hurdle
Integration with artificial
intelligence and big data
Tracking analysis
3D virtual surgical planning
software (i.e. oculus rift )
www.pcworld.com
A R D E V I C E N E E D S
Integrate patient data in visual field pre, intra and post-op
Enhance consultations in real-time
Make surgical education more visual and hands- on
Synthesize images and video into medical documentation
"Of course nobody knows anything. You just get
what information you can through the windows of your
five senses, and then make your guesses.
When they're wrong, you pay the penalty."
R E F E R E N C E S
Two broad areas for which AR devices can be used to interface with the EMR:
1. Armstrong, D. G., Rankin, T. M., Giovinco, N. A., Mills, J. L. & Matsuoka, Y. A Heads-Up Display
for Diabetic Limb Salvage Surgery A View Through the Google Looking Glass. J. Diabetes Sci.
Technol. 8, 951–956 (2014).
2. Berger, A. J., Gaster, R. S. & Lee, G. K. Development of an Affordable System for Personalized Video-
Documented Surgical Skill Analysis for Surgical Residency Training. Ann. Plast. Surg. (2013).
doi:10.1097/SAP.0b013e31827e513c
3. Waxman, B. P. Medicine in small doses. ANZ J. Surg. 84, 907–907 (2014).
4. Assad-Kottner, C., Hakeem, A., Fontenot, E. & Uretsky, B. F. ‘Tele-mentoring’: an interventional procedure
using a wearable computer: first-in-man. J. Am. Coll. Cardiol. 63, 1022 (2014).
5. Carenzo, L. et al. Disaster medicine through Google Glass. Eur. J. Emerg. Med. Off. J. Eur. Soc. Emerg. Med.
(2014). doi:10.1097/MEJ.0000000000000229
6. Schreinemacher, M. H., Graafland, M. & Schijven, M. P. Google glass in surgery. Surg. Innov. 21, 651–652
(2014).
7. Lindeque, B. G. P. et al. Emerging technology in surgical education: combining real-time augmented
reality and wearable computing devices. Orthopedics 37, 751–757 (2014).
8. Jeroudi, O. M. et al. Accuracy of Remote Electrocardiogram Interpretation With the Use of Google Glass
Technology. Am. J. Cardiol. 0,
9. Shakil, I., Tran, P. & Dehy, R. System and method for augmenting healthcare-provider performance.
(2014). at <http://www.google.com/patents/US20140222526>
10. Emergency providers see big potential for Google Glass. ED Manag. Mon. Update Emerg. Dep. Manag. 26,
55–58 (2014)

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ARVR TECH TALK

  • 1. glass A U G M E N T E D A N D V I R T U A L R E A L I T Y I N P L A S T I C S U R G E R Y Jonathan Kanevsky, MD Mirko Gilardino, MD Samuel Lin, MD
  • 2. O U T L I N E DEVICE DEMO REALITY SPECTRUM AR VR HARDWARE AR VR APPLICATIONS
  • 3. Franz Robaud – 1812-Battle of Borodino
  • 4.
  • 6.
  • 9. S P E C T R U M O F R E A L I T Y Motronheilig.com
  • 10. W H A T I S M I X E D R E A L I T Y ? MR devices combine input from multiple sensors in a wearable platform An on-board computer integrates this information between the device, the Internet, and the outside world The processed data is then relayed to the user through a visual display
  • 11. W H A T I S V I R T U A L R E A L I T Y ?
  • 12. W H A T I S V I R T U A L R E A L I T Y ?
  • 13. W H A T I S A U G M E N T E D R E A L I T Y ? • Spatial AR • Hand Held • Virtual Retina Display • Contact Lens • Head Mounted Display
  • 14. W H A T I S A U G M E N T E D R E A L I T Y ? Spatial Augmented Reality
  • 15.
  • 16. W H A T I S A U G M E N T E D R E A L I T Y ? Hand Held AR
  • 17. W H A T I S A U G M E N T E D R E A L I T Y ? Contact lens AR http://www.extremetech.com/computing/126043-us-military-developing-multi- focus-augmented-reality-contact-lenses
  • 18. W H A T I S A U G M E N T E D R E A L I T Y ? Virtual Retina Display http://www.extremetech.com/computing/126043-us-military-developing-multi- focus-augmented-reality-contact-lenses
  • 19. W H A T I S A U G M E N T E D R E A L I T Y ? www.dailymail.co.ukwww.dailymail.co.uk Head Mounted Display Google glass Meta
  • 20. H O L O L E N S M I C R O S O F T
  • 21. H O L O L E N S M I C R O S O F T
  • 22. A P P L I C A T I O N S I N P L A S T I C S U R G E R Y Voice activated head-mounted camera optimal for hands free recording form surgeon POV Generate teaching libraries for plastic surgery eduction or record resident technique S U R G I C A L E D U C A T I O N : www.ucsf.edu Gaster and Lin, 2014
  • 23. P L A S T I C S U R G E R Y A P P L I C A T I O N S Augmented reality display for: - Diagrams - Anatomical markings - -AI applications S U R G I C A L E D U C A T I O N : Gaster , Lin, Kanevsky, Corban 2015
  • 24. S U R G I C A L E D U C A T I O N : Ma M, Fallavollita P, Seelbach I, et al. Personalized augmented reality for anatomy education. Clinical anatomy (New York, N.Y.). 2016;29(4):446-453
  • 25. S U R G I C A L E D U C A T I O N :
  • 26. S U R G I C A L E D U C A T I O N :
  • 27. S U R G I C A L E D U C A T I O N :
  • 28. Transmit visual information for diagnosis and surgical planning Trainees can call a senior surgeon to discuss a diagnosis Virtual assistance during procedures with other surgeons in HUD T E L E M E D I C I N E : internetmedicine.com P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 30. D A T A O V E R L A Y A N D D O C U M E N T A T I O N : internetmedicine.com Accessing patient information: CT scans, MRIs, X-rays, patient notes, labs or vital signs all while remaining sterile in the operating room. Generating new notes: OR dictations with embedded video during surgery Peri-operative utility: Pre-operative markings, Post- operative photos P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 31.
  • 32. C O N S U L T A T I O N : http://www.illusioimaging.com/ P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 33. P E R I O - O P E R A T I V E : P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 34. P A T I E N T C A R E : internetmedicine.com P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 35. P A T I E N T C A R E : internetmedicine.com Perioperative Pain and Anxiety P L A S T I C S U R G E R Y A P P L I C A T I O N S
  • 36. G A T E C O N T R O L T H E O R Y
  • 37. L I M I T A T I O N S Two broad areas for which AR devices can be used to interface with the EMR: • HIPAA compliance • Distraction of Surgeon – Delayed response time an decreased awareness • Cost effective innovation
  • 38. T H E N E X T S T E P Two broad areas for which AR devices can be used to interface with the EMR: Adoption by the surgical community is a major hurdle Integration with artificial intelligence and big data Tracking analysis 3D virtual surgical planning software (i.e. oculus rift ) www.pcworld.com
  • 39. A R D E V I C E N E E D S Integrate patient data in visual field pre, intra and post-op Enhance consultations in real-time Make surgical education more visual and hands- on Synthesize images and video into medical documentation
  • 40. "Of course nobody knows anything. You just get what information you can through the windows of your five senses, and then make your guesses. When they're wrong, you pay the penalty."
  • 41. R E F E R E N C E S Two broad areas for which AR devices can be used to interface with the EMR: 1. Armstrong, D. G., Rankin, T. M., Giovinco, N. A., Mills, J. L. & Matsuoka, Y. A Heads-Up Display for Diabetic Limb Salvage Surgery A View Through the Google Looking Glass. J. Diabetes Sci. Technol. 8, 951–956 (2014). 2. Berger, A. J., Gaster, R. S. & Lee, G. K. Development of an Affordable System for Personalized Video- Documented Surgical Skill Analysis for Surgical Residency Training. Ann. Plast. Surg. (2013). doi:10.1097/SAP.0b013e31827e513c 3. Waxman, B. P. Medicine in small doses. ANZ J. Surg. 84, 907–907 (2014). 4. Assad-Kottner, C., Hakeem, A., Fontenot, E. & Uretsky, B. F. ‘Tele-mentoring’: an interventional procedure using a wearable computer: first-in-man. J. Am. Coll. Cardiol. 63, 1022 (2014). 5. Carenzo, L. et al. Disaster medicine through Google Glass. Eur. J. Emerg. Med. Off. J. Eur. Soc. Emerg. Med. (2014). doi:10.1097/MEJ.0000000000000229 6. Schreinemacher, M. H., Graafland, M. & Schijven, M. P. Google glass in surgery. Surg. Innov. 21, 651–652 (2014). 7. Lindeque, B. G. P. et al. Emerging technology in surgical education: combining real-time augmented reality and wearable computing devices. Orthopedics 37, 751–757 (2014). 8. Jeroudi, O. M. et al. Accuracy of Remote Electrocardiogram Interpretation With the Use of Google Glass Technology. Am. J. Cardiol. 0, 9. Shakil, I., Tran, P. & Dehy, R. System and method for augmenting healthcare-provider performance. (2014). at <http://www.google.com/patents/US20140222526> 10. Emergency providers see big potential for Google Glass. ED Manag. Mon. Update Emerg. Dep. Manag. 26, 55–58 (2014)

Editor's Notes

  1. The paintings created a new illusion, transporting the viewer into a virtual reality, creating the perception of being physically present in the middle of the events. When standing in the middle of the 360 degree panorama this created the impression of standing in a new environment.[3]
  2. 1838 Charles Wheatstone’s research demonstrated that the brain processes the different two-dimensional images from each eye into a single object of three dimensions. Viewing two side by side stereoscopic images or photos through a stereoscope gave the user a sense of depth and immersion. 
  3. 1838 Charles Wheatstone’s research demonstrated that the brain processes the different two-dimensional images from each eye into a single object of three dimensions. Viewing two side by side stereoscopic images or photos through a stereoscope gave the user a sense of depth and immersion. 
  4. 1930s a story by science fiction writer Stanley G. Weinbaum (Pygmalion’s Spectacles) contains the idea of a pair of goggles that let the wearer experience a fictional world through holographics, smell, taste and touch. In hindsight the experience Weinbaum describes for those wearing the goggles are uncannily like the modern and emerging experience of virtual reality, making him a true visionary of the field.
  5. 1950s cinematographer Morton Heilig developed the Sensorama (patented 1962) which was an arcade-style theatre cabinet that would stimulate all the senses, not just sight and sound. It featured stereo speakers, a stereoscopic 3D display, fans, smell generators and a vibrating chair. The Sensorama was intended to fully immerse the individual in the film. He also created six short films for his invention all of which he shot, produced and edited himself. The Sensorama films were titled, Motorcycle, Belly Dancer, Dune Buggy, helicopter, A date with Sabina and I’m a coca cola bottle!
  6. 1960 – The first VR Head Mounted Display Morton Heilig’s next invention was the Telesphere Mask (patented 1960) and was the first example of a head-mounted display (HMD), albeit for the non-interactive film medium without any motion tracking. The headset provided stereoscopic 3D and wide vision with stereo sound.
  7. AR integrates backrgound visuals VR full visual field immersion
  8. Discuss device specs
  9. Discuss device specs
  10. Rosen JM, Long SA, McGrath DM, Greer SE. Simulation in plastic surgery training and education: the path forward. Plastic and reconstructive surgery. 2009;123(2):729- 738; discussion 739-740. 

  11. With augmented reality, in contrast to virtual reality, surgeons can show patients their perspective or decision-process and provide patients an improved understanding of the surgical pathway (Figure 26). Both surgeon and patient could look at patient data or surgical steps together, helping put the patient at ease with a surgeon’s plan and thought process.
  12. With augmented reality, in contrast to virtual reality, surgeons can show patients their perspective or decision-process and provide patients an improved understanding of the surgical pathway (Figure 26). Both surgeon and patient could look at patient data or surgical steps together, helping put the patient at ease with a surgeon’s plan and thought process.
  13. 34 A complication and foreign body were added into the operating field, and the detection rates of surgeons with AR and those without any added mixed reality were measured. 34 Surgeons using AR were significantly more accurate, but were also significantly worse at detecting the unexpected events As mixed reality devices come to market, there must be a process to evaluate whether the technology will add true benefit to the patient, or will it simply enhance the surgical experience while increasing costs.35 For many procedures, the benefit of augmented or virtual reality may not be outweighed by the added cost of integrating these technologies into the clinical setting.
  14. Is it unwise for us not to adopt and incorporate this technology into out practice. For enhancing our vision, augments your senses. The penalty we have is poorer outcmes and themissed chance to provide better care for our patients