Introduction to Mixed Reality in Surgery
What is Mixed Reality?
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Mixed Reality (MR) combines real and virtual worlds so that doctors can interact with 3D digital objects during surgery.
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First described by Paul Milgram in 1994 as a space between real life and full virtual reality.
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It sits on a technology spectrum:
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Reality – Augmented Reality (AR) – Mixed Reality (MR) – Virtual Reality (VR)
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Popular MR Devices:
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Microsoft HoloLens (since 2017)
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Magic Leap
Market Growth:
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The AR/VR industry is expected to grow from $2.7 billion to nearly $10 billion in the next 5 years (about a 350% increase).
How Does Mixed Reality Work in Surgery?
Head-Mounted Displays (HMDs):
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Worn like goggles, keeping surgeons’ hands free.
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Controlled by voice or hand gestures.
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Can show 3D images (like bones or implants) right in the surgeon’s view.
Planning and Navigation:
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Uses CT or MRI scans for 3D surgical planning.
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Helps guide tools and implants accurately during surgery.
Why Use Mixed Reality in Upper Limb Surgeries?
Challenges in These Surgeries:
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The anatomy is complex (small bones, nerves, blood vessels).
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Accuracy is critical (like placing implants in the right spot)., eg., glenoid pin placement
How MR Helps:
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Shows a 3D view of the surgical area.
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Allows real-time planning and adjustment.
Applications of Mixed Reality in Surgery
Before Surgery (Preoperative):
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Maps fractures in 3D (e.g., scapula, humerus).
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Helps pick the right size and position for implants.
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Used for surgical practice and simulation.
During Surgery (Intraoperative):
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Live navigation for accurate tool placement.
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Shows holographic “guides” to assist.
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Enables remote input from expert surgeons.
Benefits in Orthopedic Trauma
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Real-time 3D feedback improves surgical precision.
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Can lead to:
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Shorter surgeries
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Less radiation exposure
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More accurate outcomes
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Examples in Specific Conditions
Proximal Humerus Fractures:
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Problem: Fracture is hard to visualize.
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MR helps plan reduction and guide pin placement.
Elbow Stabilization:
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Problem: Transepicondylar axis drilling accuracy
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MR shows the correct angle with a 3D guide (Holographic axis alignment
Cubitus Varus Osteotomy (arm deformity correction):
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Problem: High complication risk.
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MR allows for accurate cut planning and adjustment.
Reverse Shoulder Replacement:
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Problem: Placing the glenoid implant correctly is tough.
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MR supports 3D pre-surgical planning and real-time guidance.
Rotator Cuff Repair:
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Problem: Finding the right portal
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MR shows how to do Virtual humerus rotation for footprint access
Glenoid Reconstruction (shoulder bone loss):
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Problem: Bone loss in instability
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mixed reality Solution: Distal tibia allograft shaping via holograms
AC Joint Repair:
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Problem: Coracoid Drilling accuracy is low with traditional methods.
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MR improves drill guidance and positioning using holograms.
Tumor Surgery (Oncology):
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Problem: Tumors near important nerves or vessels.
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MR shows both the tumor and surrounding anatomy in 3D.
Remote Collaboration and Training
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Surgeons can stream surgeries live for expert help.
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Trainees can practice surgeries using virtual reality simulations.
Key Benefits of Mixed Reality
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Very precise (up to ±1 mm accuracy)
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Less radiation (less need for X-rays during surgery)
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Shorter surgery time (up to 20% faster)
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Better education and training for new surgeons
Challenges and Limitations
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Expensive devices and software
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Requires training to use
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May have occasional tech issues
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Takes time to plan surgeries in 3D
Future Outlook
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Integration with AI for automatic surgical planning
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More affordable and compact devices
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Broader use in operating rooms around the world
Conclusion
Mixed Reality is transforming the way upper limb surgeries are done.
It helps surgeons work more precisely, quickly, and safely.
As the technology improves and becomes more affordable, it’s likely to become a standard part of modern surgery.
Very helpuful for practice sir