Surgery (St Vincent's) - Theses
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ItemOptimising real-time surgical navigation interface design: enhancing spatial awareness while limiting distraction( 2017)Modern diagnostic imaging techniques allow surgeons to preoperatively scrutinise anatomy and pathology in an ever more precise fashion. Surgical planning may be honed to minimise access and perform targeted yet thorough procedures. Image guided surgery systems help integrate this valuable data into the operating theatre to aid spatial awareness during surgery. Advanced navigational displays show promise in providing surgeons with real-time image guidance presented in an intuitive manner during a procedure. In addition to standard 2-dimensional cross-sectional views, options for visual presentation include 3-dimensional virtual views and augmented reality. Live computer-assisted feedback may include a 3-dimensional visual representation of tool position and critical structure’s with proximity auditory alerts. Although orientation may be enhanced, additional stimuli inherently demand some attention from the operator. An ideal user interface would provide accurate and accessible navigational data with minimal distraction. This thesis explores, through pre-clinical navigation and dissection trials, ways to provide the potential benefits of surgical precision and efficiency while mitigating distracting cues. Cadaver dissection trials allowed structured testing of the new technology, which is directly compared to conventional systems. Real-time surgical navigation systems are shown to enhance spatial awareness while reducing task workload during complex endoscopic skull base surgery. These systems showed particular promise where there was high spatial demand, compromised visual landmarks and proximity to critical structures. World first surgical studies investigating the attentional cost of advanced navigational displays highlight the potential dangers of this technology. The concept of inattentional blindness is introduced into the surgical literature with experimental evidence of its existence. Augmented reality advanced navigational displays are shown to increase inattentional blindness with a reduced detection of unexpected but salient findings. The findings serve to caution injudicious adoption of this technology and reinforce the need for pre-clinical human factors testing.