JMIR Publications

ABSTRACT

Background:

Neuraxial anesthesia is conventionally performed using a landmark-based technique. Pre-procedural ultrasound (US) is often used in challenging clinical scenarios. The procedure is then carried out by the operator recreating the US needle path from memory. We suggest that a needle guidance system utilizing the Microsoft HoloLens mixed reality (MR) headset, which projects a hologram of the ideal needle path, can assist operators in replicating the correct needle angulation and result in fewer needle passes.

Objective:

The study’s objective was to develop software for the HoloLens which could be used to augment the performance of neuraxial anesthesia and establish its face validity in lumbar spine phantom models.

Methods:

The HoloLens is a self-contained, head-mounted holographic computing device. We developed an US transducer marker and software for the HoloLens which registers the position and angulation of the US transducer during pre-procedural scans. Once an image of a clear path from skin to the intrathecal space is acquired, a hologram of the ideal needle path is projected onto the user’s visual field. The US probe is removed while the hologram remains to visualize the needle trajectory during the procedure as if conducting real-time US.

Results:

Preliminary work with lumbar spine phantoms demonstrates that novice and experienced operators can rapidly learn to use holograms to perform neuraxial anesthesia. Furthermore, this system was used safely and successfully to perform a spinal block for a patient undergoing orthopedic surgery via a single needle pass.

Conclusions:

Our study shows promising results for performing neuraxial anesthesia in phantoms and in one patient using the HoloLens. Although this may have wide-ranging implications for image-guided therapies, further study is required to quantify the accuracy and safety benefit of using holographic guidance.