Review Korean J Otorhinolaryngol-Head Neck Surg 2018;61(5):227-34 / pissn 2092-5859 / eissn 2092-6529 https://doi.org/10.3342/kjorl-hns.2018.00283 Virtual Reality in Endoscopic Sinus Surgery and Facial Plastic & Reconstructive Surgery Yong Gi Jung 1,2 and Jung-yon Ko 2 1 Department of Otorhinolaryngology-Head and Neck Surgery, 2 Virtual Reality Laboratory, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea 부비동내시경수술과안면성형재건술에적용가능한가상현실기술 정용기 1,2 고정연 2 성균관대학교의과대학삼성창원병원이비인후과학교실, 1 가상현실연구소 2 Received March 24, 2018 Accepted April 18, 2018 Address for correspondence Yong Gi Jung, MD, PhD Department of Otorhinolaryngology- Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158 Paryong-ro, Masanhoewon-gu, Changwon 51353, Korea Tel +82-55-233-5982 Fax +82-55-233-5441 E-mail ent.jyg@gmail.com With the recent development of information and communication technology, social interest in virtual reality (VR) is increasing rapidly. VR technology is expanding into applications such as games, movies, entertainment, healthcare, education/media, manufacturing, and construction. In the healthcare, VR is used for surgical training, medical education, rehabilitation medicine, pain control, and treatment for psychiatric disorder, but the market size of VR in healthcare is not big compared to VR application in other industries. However, as the demand for high-quality medical care increases and the training time of the resident physicians is reduced, the demand for VR in the healthcare is expected to increase rapidly. Especially, the nose and paranasal sinus are composed of complicated osseous structures, which makes it difficult to understand the exact anatomy and requires highly skilled techniques to perform accurate and safe surgery. For this reason, nose and sinus are a suitable field to apply VR technology. In this review article, we describe the overview of VR technology used in healthcare, the status and prospects of VR in endoscopic sinus surgery and facial plastic surgery. Korean J Otorhinolaryngol-Head Neck Surg 2018;61(5):227-34 Key Words Education ㆍ Paranasal sinuses ㆍ Plastic surgery ㆍ Simulation training ㆍ Virtual reality. 서 론 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2018 Korean Society of Otorhinolaryngology-Head and Neck Surgery 227
Korean J Otorhinolaryngol-Head Neck Surg 2018;61(5):227-34 The Concepts of Virtual Reality Fig. 1. A conceptual illustration of virtual reality for surgery and anatomy training. The medical images are reconstructed three - dimensionally by a computer and transmitted to the HMD, and the user manipulates the 3D model through the HMD and the motion controller. The HMD incorporates a gyro sensor to recognize and reflect the movement of the user's head. HMD: head mounted display. 228
VR in Nasal Surgery Jung YG, et al. Fig. 2. A Google card board which the user folds the paper and creates it directly. It has made a great contribution to the growth of VR by making it possible to experience VR at very low price of less than 10$. A picture was Adapted from Google cardboard. Available from: www.google.com/get/cardboard. VR: virtual reality. Virtual Reality in Medicine - - Table 1. Current and emerging applications of virtual reality in medicine Application Medical/dental surgical training Pre-surgical planning Computer-aided surgery systems Interactive 3d diagnostic imaging Radiation treatment planning and control Medical education 3D visualization for telemedicine Telesurgery Rehabilitation and sports medicine Disability solutions Neurological evaluation Psychiatric and behavioral healthcare Description Training and rehearsing a surgical procedure using surgical instruments linked to a realistic simulation-may or may not include haptic feedback. Using 3D radiological images and computer workstation tools to design and plan an operative procedure. Using 3D images overlaid in real-time on the operating field to facilitate surgery. Tools for data analysis and quantitative comparisons-capturing and manipulating medical imaging data in a 3D format. Collaborative environments. Design of radiation treatment procedure to match patients anatomy precisely. 3D design and control systems. Case histories, 3D anatomy lessons and virtual cadavers, procedure training, emergency room ward simulation, palpation training, etc. Radiological image tele-consultation and second opinions, shared data for tumor review boards, remote patient examination, and specialty consults. Computer-assisted surgery at a distance. Predictive algorithms, 3D surgical planning. Simulated environments for evaluation and rehabilitation-occupational therapy, physical therapy, ergonomics, orthopedics, and sports medicine. Augmented reality environments for treatment of autism and other cognitive impairments. Environmental control systems. Standardized simulated environments for evaluation of cognitive processing, stroke deficits, memory disorders, movement disorders, and higher-functions. Evaluation and treatment of cognitive and behavioral disorders: phobias, anxiety, social affect disorders, attention deficiency hyperactive disorder, post-traumatic stress disorder, and addiction treatment. Adapted from Greenleaf W. Medical applications of virtual reality. Available from: http://bme2.aut.ac.ir/~towhidkhah/mi/discussion86-1/vr%2520med%2520overview.pdf 9 www.kjorl.org 229
Korean J Otorhinolaryngol-Head Neck Surg 2018;61(5):227-34 - Technical Steps to Implement VR Fig. 3. Digital imaging and communication in medicina segmentation tool (InVesalius, CTI, Campinas, Brazil) for acquiring 3D model from computed tomography images. The Maxillary sinus is set as a region of interest. 230
VR in Nasal Surgery Jung YG, et al. Virtual Reality in Sinus Surgery - A B Fig. 4. Maxillary sinus 3D model from thin sectioned computed tomography images (A). Virtual reality image made with a 3D model of a maxillary sinus, a view from the inside of a maxilla. The maxillary sinus natural ostium can be identified (B). Fig. 5. The created maxillary sinus virtual reality images are viewed using the window mixed reality (Microsoft, Redmond, WA, USA) device Odyssey (Samsung electronic company, Seoul, Korea). www.kjorl.org 231
Korean J Otorhinolaryngol-Head Neck Surg 2018;61(5):227-34 Virtual Reality in Facial Plastic and Reconstructive Surgery - Fig. 6. Most commonly used haptic devices, Touch (3D systems, Rock Hill, SC, USA). Each joint has a motor, so it shows pre-programmed recoil action according to the movement of the user. Adapted from 3D Systems. Available from: https://ko.3dsystems. com. Fig. 7. VR camera for facial plastic and reconstruction surgery (360 round, Samsung electronic company, Seoul, Korea) which is installed in Samsung Changwon Hospital operating room. With 17 lenses, it is possible to record high-resolution images and implement VR environment. VR: virtual reality. 232
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