Imperial College London


Faculty of MedicineDepartment of Surgery & Cancer




+44 (0)20 3312 5525p.pratt Website




005Paterson WingSt Mary's Campus






BibTex format

author = {Marcus, HJ and Pratt, P and Hughes-Hallett, A and Cundy, TP and Marcus, AP and Yang, G-Z and Darzi, A and Nandi, D},
doi = {10.1016/S0140-6736(15)60379-8},
pages = {S64--S64},
publisher = {Elsevier},
title = {Comparative effectiveness and safety of image guidance systems in surgery: a preclinical randomised study.},
url = {},
year = {2015}

RIS format (EndNote, RefMan)

AB - BACKGROUND: Over the past decade image guidance systems have been widely adopted in specialties such as neurosurgery and otorhinolaryngology. Nonetheless, the evidence supporting the use of image guidance systems in surgery remains limited. New augmented reality systems offer the possibility of enhanced operating room workflow compared with existing triplanar image displays, but recent studies have highlighted several concerns, particularly the risk of inattentional blindness and impaired depth perception. The aim of this study was to compare simultaneously the effectiveness and safety of various image guidance systems against standard surgery. METHODS: In this preclinical randomised study design 50 novice surgeons were allocated to no image guidance, triplanar display, always-on solid overlay, always-on wire mesh overlay, or on-demand inverse realism overlay. Each participant was asked to identify a basilar tip aneurysm in a validated model head. The primary outcomes were time to task completion, and tool path length. The secondary outcomes were recognition of an unexpected finding (a surgical clip) and subjective depth perception (using a Likert scale). FINDINGS: Surgeons' time to task completion and tool path length were significantly lower in groups using any form of image guidance than in groups with no image guidance (p<0·001 and p=0·003, respectively). The tool path distance was also lower in groups using augmented reality than in those using triplanar display (p=0·010). Always-on solid overlay resulted in the greatest inattentional blindness (20% recognition of unexpected finding by all surgeons). Wire mesh and on-demand overlays mitigated but did not negate inattentional blindness, and were comparable with triplanar display (40% recognition of unexpected finding in all groups). Wire mesh and inverse realism overlays also resulted in better subjective depth perception than always-on solid overlay (p=0·031 and p=0·008, re
AU - Marcus,HJ
AU - Pratt,P
AU - Hughes-Hallett,A
AU - Cundy,TP
AU - Marcus,AP
AU - Yang,G-Z
AU - Darzi,A
AU - Nandi,D
DO - 10.1016/S0140-6736(15)60379-8
EP - 64
PB - Elsevier
PY - 2015///
SN - 0140-6736
SP - 64
TI - Comparative effectiveness and safety of image guidance systems in surgery: a preclinical randomised study.
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