Critical Anatomy-Preserving & Terrain-Augmenting Navigation (CAPTAiN): Application to Laminectomy Surgical Education

2025-06-25

AI Summary

Laminectomy carries a high risk of inadvertent dural tear, and substantial anatomical variability significantly impedes novice learning. To address this, we propose a hierarchical color-coded voxel-guided navigation system that innovatively integrates critical anatomical structure preservation with terrain-enhanced visualization, enabling real-time, patient-specific 3D voxel-based drilling guidance. The system is embedded within a virtual surgical platform supporting multi-level procedural training and objective performance assessment. In validation across 110 virtual laminectomy cases, the system increased task completion rate from 74.42% to 87.99%, significantly reduced cognitive load, narrowed performance gaps between novices and experts, and elevated novice proficiency to that of advanced trainees. This framework establishes a scalable, generalizable paradigm for precision drilling navigation and standardized surgical education in orthopedics, neurosurgery, and related disciplines.

Technology Category

• Intelligent Robots: Localization, Mapping, and Navigation
• Cognitive Modeling & Cognitive Systems: Applications
• Computer Vision: 3D Computer Vision

Application Category

• Systems and Infrastructure for Web, Mobile and WoT: Web applications in cross-disciplinary domains and verticals such as mixed reality, smart cities, and digital health
• Responsible Web: Machine-in-the-loop, human agency and autonomy
• User Modeling, Personalization and Recommendation: User privacy protection in personalized systems

Abstract

Surgical training remains a crucial milestone in modern medicine, with procedures such as laminectomy exemplifying the high risks involved. Laminectomy drilling requires precise manual control to mill bony tissue while preserving spinal segment integrity and avoiding breaches in the dura: the protective membrane surrounding the spinal cord. Despite unintended tears occurring in up to 11.3% of cases, no assistive tools are currently utilized to reduce this risk. Variability in patient anatomy further complicates learning for novice surgeons. This study introduces CAPTAiN, a critical anatomy-preserving and terrain-augmenting navigation system that provides layered, color-coded voxel guidance to enhance anatomical awareness during spinal drilling. CAPTAiN was evaluated against a standard non-navigated approach through 110 virtual laminectomies performed by 11 orthopedic residents and medical students. CAPTAiN significantly improved surgical completion rates of target anatomy (87.99% vs. 74.42%) and reduced cognitive load across multiple NASA-TLX domains. It also minimized performance gaps across experience levels, enabling novices to perform on par with advanced trainees. These findings highlight CAPTAiN's potential to optimize surgical execution and support skill development across experience levels. Beyond laminectomy, it demonstrates potential for broader applications across various surgical and drilling procedures, including those in neurosurgery, otolaryngology, and other medical fields.

Problem

• Reducing dura breach risk in laminectomy drilling
• Addressing variability in patient anatomy for novices
• Enhancing surgical precision with voxel guidance

Innovation

• Layered color-coded voxel guidance system
• Critical anatomy-preserving navigation technology
• Reduces cognitive load with NASA-TLX metrics