Creating a Digital Twin of Spinal Surgery: A Proof of Concept

Surgery digitalization is the process of creating a virtual replica of real-world surgery, also referred to as a surgical digital twin (SDT). It has significant applications in various fields such as education and training, surgical planning, and automation of surgical tasks. Given their detailed representations of surgical procedures, SDTs are an ideal foundation for machine learning methods, enabling automatic generation of training data. In robotic surgery, SDTs can provide realistic virtual environments in which robots may learn through trial and error. In this paper, we present a proof of concept (PoC) for surgery digitalization that is applied to an ex-vivo spinal surgery performed in realistic conditions. The proposed digitalization focuses on the acquisition and modelling of the geometry and appearance of the entire surgical scene. We employ five RGB-D cameras for dynamic 3D reconstruction of the surgeon, a high-end camera for 3D reconstruction of the anatomy, an infrared stereo camera for surgical instrument tracking, and a laser scanner for 3D reconstruction of the operating room and data fusion. We justify the proposed methodology, discuss the challenges faced and further extensions of our prototype. While our PoC partially relies on manual data curation, its high quality and great potential motivate the development of automated methods for the creation of SDTs. The quality of our SDT can be assessed in a rendered video available at https://youtu.be/LqVaWGgaTMY .

Domain adaptation strategies for 3D reconstruction of the lumbar spine using real fluoroscopy data

This study tackles key obstacles in adopting surgical navigation in orthopedic surgeries, including time, cost, radiation, and workflow integration challenges. Recently, our work X23D showed an approach for generating 3D anatomical models of the spine from only a few intraoperative fluoroscopic images. This negates the need for conventional registration-based surgical navigation by creating a direct intraoperative 3D reconstruction of the anatomy. Despite these strides, the practical application of X23D has been limited by a domain gap between synthetic training data and real intraoperative images. In response, we devised a novel data collection protocol for a paired dataset consisting of synthetic and real fluoroscopic images from the same perspectives. Utilizing this dataset, we refined our deep learning model via transfer learning, effectively bridging the domain gap between synthetic and real X-ray data. A novel style transfer mechanism also allows us to convert real X-rays to mirror the synthetic domain, enabling our in-silico-trained X23D model to achieve high accuracy in real-world settings. Our results demonstrated that the refined model can rapidly generate accurate 3D reconstructions of the entire lumbar spine from as few as three intraoperative fluoroscopic shots. It achieved an 84% F1 score, matching the accuracy of our previous synthetic data-based research. Additionally, with a computational time of only 81.1 ms, our approach provides real-time capabilities essential for surgery integration. Through examining ideal imaging setups and view angle dependencies, we've further confirmed our system's practicality and dependability in clinical settings. Our research marks a significant step forward in intraoperative 3D reconstruction, offering enhancements to surgical planning, navigation, and robotics.