BREAST+: An augmented reality interface that speeds up perforator marking for DIEAP flap reconstruction surgery

Area of Science:

• Medical technology
• Surgical innovation
• Augmented reality in medicine

Background:

• Deep inferior epigastric artery perforator flap reconstruction is vital for breast cancer patients.
• Current preoperative planning relies on 2D imaging and radiological reports for perforator vessel identification.
• Accurate localization of perforator vessels is crucial for successful flap surgery.

Purpose of the Study:

• To introduce BREAST+, an augmented reality interface for HoloLens 2, to improve preoperative planning in breast reconstruction.
• To facilitate accurate marking of perforator locations on patient skin and provide seamless access to clinical data in the operating room.
• To evaluate the efficiency and accuracy of the BREAST+ system compared to conventional methods.

Main Methods:

• A user study was conducted with 27 medical students and 2 breast surgeons in a controlled setting.
• Quantitative metrics (marking error, task completion time, repetitions) and qualitative data (usability, workload, satisfaction) were collected.
• BREAST+ system performance was assessed during perforator marking tasks.

Main Results:

• The BREAST+ system demonstrated an average marking time of 7.7 ± 6.5 seconds per perforator.
• Average absolute error was 6.8 ± 2.6 mm, with an estimated average deviation of 3.6 ± 1.4 mm.
• Despite minor depth perception biases, BREAST+ was approximately 6 times faster than conventional methods.

Conclusions:

• BREAST+ offers an accurate and significantly more efficient approach to perforator marking in breast reconstruction surgery.
• Augmented reality technology holds promise for enhancing surgical planning and execution.
• Further research may address depth perception inaccuracies to optimize AR system performance.