Referencing for intraoperative navigation: Evaluation of human bias

Area of Science:

• Oral and Maxillofacial Surgery
• Medical Imaging
• Surgical Navigation

Background:

• Navigation-assisted surgery is essential for complex midface and facial skeleton reconstructions.
• Accurate identification of reference points is critical for the precision of surgical navigation systems.
• Current methods rely on artificial and anatomical landmarks, but human error in placement can compromise accuracy.

Purpose of the Study:

• To investigate the incidence and nature of human errors in reference point placement for navigation-assisted surgery.
• To quantify discrepancies between planned and actual reference point positions.
• To compare the accuracy of different referencing methods.

Main Methods:

• Retrospective analysis of 228 reference point positions across 51 navigation-assisted surgery cases.
• Quantification of discrepancies using Brainlab iPlanCMF software.
• Evaluation of referencing methods including dental splints, osteosynthesis materials, anatomical landmarks, and combinations thereof.

Main Results:

• The average discrepancy between planned and actual reference points was 0.29 ± 0.41 mm.
• Anatomical landmarks showed significantly lower deviation compared to other methods (p < 0.05).
• No statistically significant differences in error were found between dental splints, osteosynthesis materials, or their combinations.

Conclusions:

• Reference point misplacement occurred more frequently than anticipated, potentially due to human bias or intraoperative challenges like metal artifacts.
• Enhanced training for surgical personnel involved in planning navigation-assisted surgery is recommended.
• Development of novel referencing methods less prone to human bias is warranted to improve surgical navigation accuracy.