RU2707369C1 - Method for preparing and performing a surgical operation using augmented reality and a complex of equipment for its implementation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, specifically to means of preparing and performing a surgical operation using augmented reality. Method includes stages of planning a surgical operation, surgical navigation and surgical intervention using augmented reality, wherein at the stage of planning the surgical operation, a computer or magnetic resonance imaging is performed to the patient and forming a three-dimensional raster image of the patient's individual anatomy, which is transmitted to the complex of equipment for the surgical operation using the augmented reality, wherein at the stage of surgical navigation constructing a contour and three-dimensional reconstruction of all anatomical structures of interest to the surgeon in the forthcoming operation by placing three key points on the anatomical landmarks visible on the computer screen in the form of a three-dimensional model and also visible or tangible on the patient's body, wherein the points are selected to form a triangle thereof, followed by selecting a trajectory and safe limits of surgical approach, determining a transformation matrix of coordinates between the system of coordinates of the stereocamera of the complex and the coordinate system of the tomograph, in which the patient underwent diagnostics, by means of the point of the navigation pointer installation on the patient's body of the same three points and in the same sequence as the anatomical model, and fixing the points position by the computer, after installation of three key points, if necessary, additional points are placed on the same anatomical surface, followed by triggering the process of recording points with points on the surface of three-dimensional models of patient's anatomy, wherein on computer screen additionally displaying three-dimensional model of navigation pointer, wherein the position and orientation of the three-dimensional model of the navigation pointer relative to the patient's anatomy models corresponds to the physical position of the pointer relative the anatomical surface of the patient, at the surgical stage, a navigation pointer is used to search for anatomical structures of interest, access points to them, direction of their location relative to the access point, distance to them, as well as to limit the surgical approach area, at that, focusing on the image on the computer screen or in glasses of augmented reality, in the surgical approach area, the navigation pointer is installed so that the anatomical structure of interest is on the continuation line of the pointer, wherein the screen displays the distance to the anatomical structure in millimeters, and to limit the surgical approach area, focusing on the image on the computer screen or in the augmented reality glasses, moving the navigation pointer so that the pointer extension line moves along the contour of the anatomical structure of interest, pointer is moved along the projection line of the anatomical structure of interest on the body surface and the area of the forthcoming surgical approach is outlined, after which a surgical operation is performed, during which, if necessary, a new access point is established and the access area is corrected. A complex of equipment for performing a surgical operation using the augmented reality comprises a block of chambers installed above an operation field and including a chamber of augmented reality and a ToF chamber, stereo camera operating in the infrared wavelength range, augmented reality glasses comprising a control panel connected to the computer, and markers, wherein stereo camera is installed so that its visibility area includes markers made spherical and reflecting, located on camera unit, navigation pointer, enlarged reality glasses and basic marker of coordinate system, wherein the markers configuration on each of them is different from the others, the base marker of the coordinate system is rigidly fixed on the cranial clamp or the operating table, and the computer is equipped with a foot controller in the form of a unit with pedals.

EFFECT: use of inventions widens range of means for surgical interventions using augmented reality.

2 cl, 6 dwg

Description

The invention relates to medicine, namely to surgery, and can be used when performing operations in the field of surgery, namely thoracic surgery, abdominal surgery, plastic surgery, neurosurgery, traumatology, orthopedics, oncology, resuscitation, maxillofacial surgery, endocrine surgery, otorhinolaryngology.

A well-known published on the Internet "Method of intraoperative navigation based on virtual modeling in video endoscopic resection of the kidney with kidney tumors", located at: http://elibrary.ru/item.asp?id=23488789, authors
Dubrovin V.N., Egoshin A.V., Furman A.A., Rozhentsov A.A., Eruslanov R.I. The method contains a special computer program for creating a three-dimensional image of the operating space based on preoperative tomographic data of a particular patient, and allowing to form virtual 3D models of the patient according to the results of tomographic examination. This method is especially promising for training novice surgeons, it can help them acquire skills in minimally invasive surgery.

But this method is intended for training novice surgeons and involves the mandatory use of endoscopic equipment. The method does not allow interventions in open surgery, traumatology, etc. Also, this method cannot be applicable for visualization of anatomical formations lying outside the kidneys. The main guidelines for positioning the system are only the tissues of the organ, while the claimed technical solution allows you to display the entire topology of the organs.

A known registration method is described in US Pat. placing markers on the patient’s body or phantom before performing CT and / or MRI, and relying on the availability of information about the position of the markers in three-dimensional raster images of the patient’s anatomy.

The disadvantage of this method is its inapplicability in cases where CT and / or MRI are performed for diagnostic purposes without markers, and the need for surgical navigation becomes clear after studying the results of CT and / or MRI. Repeated CT and / or MRI scans with markers are associated with an increase in the total cost of diagnosis, additional time costs, and in the case of CT, with an increase in radiation exposure to the patient.

There is a method of placing an augmented reality camera in a navigation pointer, described in US patent No. US 2005015005 A1 01/20/2005 COMPUTER ENHANCED SURGICAL NAVIGATION IMAGING SYSTEM (CAMERA PROBE) / Ralf Alfons Kockro.

The disadvantage of this method is the conversion of the navigation pointer from a passive optical device to an active electronic one. The navigation pointer is a medical instrument that requires regular pre-sterilization cleaning and sterilization. Placing inside the camera’s pointer with the batteries and wireless data transfer modules necessary for its operation requires ensuring the integrity of the case and increasing its size, adding a limitation on the battery life. As a result, design becomes more complicated and the cost of the device increases, while usability decreases.

The principles of functioning of glasses with combiners based on waveguides and augmented reality systems built using such glasses are discussed in US Pat. , Matthew D. Watson and US Patent No. US 2015/0242943 A1 09/03/2015 METHOD AND SYSTEM FOR GENERATING A RETAL, EXPERIENCEUSING AN AUGMENTED REALITY SYSTEM / RonyAbovitz, Brian T. Schowengerdt, Matthew D. Watson

There is a method of implementing augmented reality without glasses based on projection of an image on the surgical field using a projector, described in US patent No. US 2014/0022283 A1 01/23/2014 AUGMENTEDREALITYAPPARATUS / HarleyHau-LamChan, MichaelJohnDaly, JonathanCrawfordIRISH.

The disadvantage of this method is the low contrast of the image obtained using the projector on a brightly lit operating field.

The closest in technical essence is the real-time navigation method of surgical intervention and the apparatus for displaying an expanded overview of the patient from the preferred static or dynamic point of view of the surgeon described in US 2016019 1887 A1, including the use of a surface image, a graphical representation of the patient’s internal anatomical structure, processed from preoperative or intraoperative images, and a computer that records both images, including determining the position of instruments and parts of the system (ToF camera, augmented reality glasses) using optical markers (p. 2, [0035]), using a stereo camera (p. 1, [0010]), using time-of-flight (ToF ) cameras (p. 1, [0007]), use of CT and MRI images as medical data (p. 5, [0073]), user construction of a segmentation and three-dimensional surface model (p. 5, [0075]), use augmented reality glasses with a transparent display based on combiners of light rays (p. 9, [0117]). This method involves determining the patient’s position based on a combination of two methods: 1) using reflective or colored markers placed directly on the anatomical landmarks on the patient’s body (p. 2, [0035]; p. 4, [ 0056]; p. 6, [0087]; p. 13, [0146]), the position of which is determined using cameras (p. 8, [0104]); 2) by scanning the surface of the patient’s body with a 3D scanner (p. 7, [0093], [0094]) when the markers shift beyond a certain threshold value (p. 7, [0095]). Thus, determining the position of the patient requires direct visibility of the patient's body or part thereof (Fig. 2), instruments are not used to determine the position of the patient (Fig. 1).

Placing markers directly on anatomical landmarks on the patient’s body is associated with the following problems:

- when choosing anatomical landmarks in the surgical field, markers placed on such landmarks prevent the continuation of surgical intervention;
- when choosing anatomical landmarks outside the surgical field, there is no direct visibility of the markers for the cameras - this is prevented by the operating linen covering the patient’s body outside the surgical field;

- markers can only be placed outside the surgical wound, so the use of anatomical landmarks inside the surgical wound becomes impossible; Scanning the surface of the patient’s body with a 3D scanner of any type, including a ToF camera, is also difficult, because the patient’s body is covered by operating linen outside the surgical field.

The present invention is aimed at expanding the functionality of the method and arsenal of equipment for preparing and performing a surgical operation using augmented reality and allowing to reduce the time of surgery and reduce the amount of injured tissue.

             The problem is solved due to the fact that the Method of preparing and performing a surgical operation using augmented reality includes the steps of planning a surgical operation, surgical navigation and surgical intervention using augmented reality, and at the stage of planning a surgical operation, the patient is subjected to computed or magnetic resonance imaging and form a three-dimensional raster image of the individual anatomy of the patient, which is transmitted to the computer of the complex of beliefs for the implementation of a surgical operation using augmented reality, while at the stage of surgical navigation, they perform the contour construction and three-dimensional reconstruction of all anatomical structures of interest to the surgeon in the upcoming operation by setting three key points on the anatomical landmarks visible on a computer screen as a three-dimensional model, and also visible or tangible on the patient’s body, moreover, the points are chosen with the possibility of the formation of a triangle by them, after which they select thorium and safe limits of surgical access, determine the coordinate transformation matrix between the coordinate system of the stereo camera of the complex and the coordinate system of the tomograph in which the patient was diagnosed by setting the tip of the navigation pointer of the complex on the patient’s body with the same three points and in the same sequence as on the anatomical models, and fixing by the computer of the complex the position of the points, after installing three key points, if necessary, establish additional points located on the same ana of the tomic surface, after which the process of registering points with points on the surface of three-dimensional models of the patient’s anatomy is started, while the three-dimensional model of the navigation pointer is additionally displayed on the computer screen, while the position and orientation of the three-dimensional model of the navigation pointer relative to the patient’s anatomy models corresponds to the physical position of the pointer relative to the anatomical surface patient, at the stage of surgical intervention, use a navigation pointer to search for anatomists of interest structures, access points to them, the directions of their location relative to the access point, the distance to them, as well as to limit the area of surgical access, while focusing on the image on a computer screen or in augmented reality glasses, a navigation pointer is set in the surgical access area in this way so that the anatomical structure of interest is on the continuation line of the pointer, while the distance to the anatomical structure in millimeters is displayed on the screen, and to limit the area These surgical access, focusing on the image on a computer screen or in augmented reality glasses, move the navigation pointer so that the continuation line of the pointer moves along the contour of the anatomical structure of interest, the pointer is moved along the projection line of the anatomical structure of interest on the body surface and outline the area of the upcoming surgical access after which they perform a surgical operation, during which, if necessary, establish a new access point and adjust the area access. Knowing the exact access area allows the surgeon to reduce the amount of injured tissue.

  The complex of equipment for carrying out a surgical operation using augmented reality includes a camera unit mounted above the surgical field and including an augmented reality camera and a ToF camera, a stereo camera operating in the infrared wavelength range, augmented reality glasses containing a control panel connected to a computer, and markers, while the stereo camera is installed in such a way that markers made of spherical and reflective located on the camera block fall on its scope igatsionnoy orders, glasses augmented reality marker and the base coordinate system, wherein the configuration of the markers in each of them is different from the other, the base coordinate system of the marker is fixedly secured to the cranial clamp or operating table, and the computer is provided with a foot controller as a unit with pedals.

In the present invention, the disadvantages of the closest analogue are solved on the basis of the following actions: 1) separation of the process of initial determination of the patient’s position and the process of tracking changes in the patient’s position; 2) the use of auxiliary tools for determining the position of the patient - a navigation pointer and a base marker of the coordinate system. Initial determination of the patient’s position is done using the navigation pointer. The navigation pointer allows you to indicate key points, both on the surface of the patient’s body open and closed by operating linen, as well as inside the wound, within the length of the pointer. Using a navigation pointer does not interfere with the continuation of surgery. Tracking changes in the patient’s position is performed using the base marker of the coordinate system, or using the ToF camera. The base marker of the coordinate system does not need to be fixed on the surface of the patient’s body, it is enough to fix it motionless relative to the surgical field: for example, to the rails of the operating table or to the cranial clamp. The base marker can be raised above the operating linen to ensure its direct visibility to the stereo camera. The ToF camera in the present invention is used to scan objects that are not necessarily the surface of the patient’s body, but are stationary relative to the surgical field: a surgical table fixed above the equipment table (for example, an instrument table), operating linen that covers the patient’s body. Comparison of images from a stereo camera with preoperative or intraoperative images of CT or MRI is performed only at the stage of initial determination of the patient's position. When tracking changes in the patient’s position, preoperative or intraoperative CT or MRI images are not used; instead, an analysis is made of changes in the position of the base marker of the coordinate system in the field of view of the stereo camera and objects in the field of view of the ToF camera. Thereby, it is possible to correct the position of the patient in the absence of direct visibility of the patient's body or its part for the cameras, which allows to avoid re-registration, and thereby reduce the time of surgery. Thus, the method of preparing and performing a surgical operation using augmented reality and the complex of equipment for its implementation can reduce the time of surgery, reduce the area of surgical intervention and minimize damage to surrounding healthy tissues.

The essence of the technical solution is illustrated by the images, where figure 1 shows the interconnection of the following devices: navigation pointer 1, base marker of the coordinate system 2, camera unit - ToF cameras and augmented reality cameras 3, stereo camera 4, augmented reality glasses 5, monitor 6, computer 7, foot controller 8, keyboard and mouse 9. Figure 2 shows a stereo camera 4. Figure 3 shows a block of cameras 3. Figure 4 shows a navigation pointer 1. Figure 5 shows the base marker of the coordinate system 2. Figure 6 shows glasses augmented reality 5.

The preparation method is as follows. At the stage of planning a surgical operation, the patient undergoes computed tomography or magnetic resonance imaging. As a result of this procedure, the tomograph workstation generates a three-dimensional raster image of the individual patient anatomy in the DICOM format. From the prior art [https://www.dicomstandard.org/about/], the DICOM standard is known - the medical industry standard governing the creation, storage, transmission and visualization of digital medical images and metadata. The DICOM file set is transferred to computer 7 of the complex for planning, managing and monitoring the results of surgical treatment. Using the data obtained, the radiologist using the software performs segmentation (contouring) and three-dimensional reconstruction (building a three-dimensional surface model) of all anatomical structures that are of interest to the surgeon in the upcoming operation. Examples of such anatomical structures are neoplasms, blood vessels, skeleton bones, and the surface of a patient's body. Further, based on the obtained 3D-model, the surgeon plans the upcoming operation. At the stage of surgical navigation, the process of determining the coordinate transformation matrix between the coordinate system of the stereo camera and the coordinate system of the tomograph in which the patient underwent diagnostics takes place. Such a transformation is necessary because the coordinates of three-dimensional surface models based on the results of CT and / or MRI are specified in the coordinate system of the tomograph, and the position of the navigation pointer1 and the patient are specified in the coordinate system of the stereo camera. In the complex software, from all prepared three-dimensional surface models of anatomical structures, one model is selected that will be used for registration. Three key points are set on the surface of the selected model using mouse 9. The points are set on anatomical landmarks visible on the screen of the monitor 6 of the computer 7 on a three-dimensional model, while being visible or tangible on the patient’s body - for example, on characteristic tubercles and hollows of bones. Points are selected so that they form a triangle. Points are not allowed to be on the same line. After setting three key points on a three-dimensional surface model, the surgeon indicates the same points in the same sequence on the patient’s body using a navigation pointer. To do this, the surgeon puts the tip of pointer 1 at each of the points and presses the mouse button 9, the keyboard key or pedal of the foot controller 8 to fix the position of the point. After setting three key points, the surgeon, if necessary, can indicate with the help of pointer 1 additional points located on the surface of the same anatomical structure as the key ones. Specifying additional points allows you to increase the accuracy of registration. After specifying points on the patient’s body, the surgeon starts the registration using the mouse button 9, the keyboard key or pedal of the foot controller 8, after which the process of registering two sets of points occurs. The first set of points is indicated by navigation mark 1 on the surface of the patient’s body, and the second set of points was obtained during three-dimensional reconstruction of anatomical models, while three such points are marked as key. After registration on the screen of monitor 6, in addition to three-dimensional models of the patient’s anatomy, a three-dimensional model of the navigation pointer 1 is displayed. The position and orientation of the pointer model relative to the patient’s anatomy models corresponds to the position of the physical pointer 1 relative to the patient. At the stage of surgical intervention, the surgeon can control the visibility and transparency of individual models - skin, bones, organs, neoplasms in them, vessels, thereby gaining an idea of their location relative to the pointer, even if these anatomical structures are hidden from the eyes in the surgical field. The following modes of displaying the navigation pointer model are available to the surgeon: side view of pointer 1 and the patient; view of the patient from the position of the tip of the pointer 1; view of the pointer model on flat sections of CT and / or MRI. Also, the surgeon can measure the shortest distance from the current position of the tip of the pointer 1 to the selected three-dimensional model of the patient’s anatomy, for example, to the neoplasm. During operations with the navigation system, after registration, surgeons often need to adjust the height, rotation and configuration of the table, while the patient moves relative to the stereo camera 4. In such cases, in order to avoid re-registration, one of two additional devices - the base marker of the coordinate system 2 or ToF camera, which is part of the block of cameras 3. The base marker of the coordinate system 2 (figure 5) is equipped with a set of spherical reflective markers. When the patient's position changes, the base marker 2 moves with the patient. The software, based on the difference between the old and the new position of the base marker 2, appropriately corrects the transformation matrix resulting from the initial registration, and thus eliminates the need for re-registration. The ToF camera, which is part of the camera unit 3, determines the distance to the surface closest to it based on the known speed of light and the time between the emission of the light signal and the receipt of the reflected signal. The result of the ToF camera is a depth map, which can be represented as a point cloud. Comparing two point clouds - before and after the patient’s movement, the software first calculates the transformation matrix corresponding to such a movement, and then with its help it corrects the transformation matrix obtained as a result of the initial registration, also eliminating the need for re-registration.

Surgery using augmented reality is as follows. After completing registration, the surgeon uses navigation pointer 1 to search for anatomical structures of interest: access points to them, directions of their location relative to the access point, distance to them, and also to limit the area of surgical access (tissue separation). Examples of anatomical structures are brain tumors or hematomas, parathyroid glands affected by adenoma, neoplasms in the canal of tubular bones, and traumatic injuries of bones. The surgeon moves pointer 1 on the surface of the body (before the start of surgical access) or in the surgical field (during the surgical access) and tilts it, observing the three-dimensional model of the pointer, the line of continuation of the pointer and three-dimensional models of the patient's anatomy on the screen or in augmented reality glasses. To search for the anatomical structure, focusing on the image on the screen 6 or in augmented reality glasses 5 (Fig. 6), the surgeon sets the navigation pointer 1 so that the anatomical structure of interest to him is on the continuation line of the pointer, sees on the screen 6 the distance in millimeters to the interesting structure. Looking from screen 6 to the surgical field and pointer 1 itself, the surgeon sees its direction and understands that the anatomical structure of interest to him is in this direction, at a depth corresponding to the distance that he saw on screen 6. To limit the area of surgical access, focusing On the image on the screen 6 or in augmented reality glasses 5, the surgeon moves the navigation pointer 1 so that the continuation line of the pointer 1 moves along the contour of the anatomical structure of interest to him. In this case, pointer 1 in the hands of the surgeon moves along the line of projection of the anatomical structure of interest on the surface of the body, and outlines the area of upcoming surgical access. Looking from the screen 6 to the surgical field, observing the movement of the pointer 1 in the surgical field, the surgeon sees the border of the area of the upcoming surgical access. The use of augmented reality during the operation does not change the set of actions of the surgeon and the sequence of their execution, but allows you to reduce the number and magnitude of the movement of the surgeon's gaze between the monitor and the surgical field. When using the augmented reality camera included in the camera unit 3, the surgeon sees an image of the surgical field behind three-dimensional models on screen 6, and if such an image is enough, do not move your eyes to the surgical field. When using augmented reality glasses 5, the surgeon sees the image of the models through the transparent combiners of glasses 5, over the image of the surgical field, and can look from the surgical field to the models without turning his head, but only focusing his eyes alternately on the surgical field and on the combiners of augmented reality glasses 5 After determining the point and / or area of surgical access, the surgeon suspends the use of navigation and performs the operation in the traditional way until then, for tions of access to it becomes necessary to clarify the direction of, or access distance, choose a new access point or adjust the access area. Thus, the augmented reality system is available to the surgeon throughout the operation, can be used at any time, but the need for its use is not constant, but arises periodically. In this case, the need to view three-dimensional models of anatomical structures during the operation and the need for navigation using pointer 1 may arise independently of each other.

A set of equipment for the preparation and execution of surgical operations using augmented reality is used as follows. The equipment of the complex is located in the operating room. The base marker of the coordinate system 2 is fixed to the operating room equipment, which is stationary relative to the surgical field, for example, to the cranial clamp or the brackets of the operating table. The surgeon puts on augmented reality glasses 5 and picks up the navigation pointer 1. The camera unit 3 is placed above the surgical field, and the stereo camera 4 is placed so that all the equipment of the complex equipped with spherical reflective markers is in its field of vision: navigation pointer 1, the basic marker of the system coordinates 2, augmented reality glasses 5, camera block 3. The configuration of the spherical reflective markers for each device is unique, which allows the software to distinguish devices from each other by expressions with a stereo camera. Navigation pointer 1 is a medical instrument that requires regular pre-sterilization cleaning and sterilization. Placing inside the camera’s pointer with the batteries and wireless data transfer modules necessary for its operation requires ensuring the integrity of the case and increasing its size, adding a limitation on the battery life. As a result, design becomes more complicated and the cost of the device increases, while usability decreases. For these reasons, the complex uses a passive optical navigation pointer 1. Augmented reality glasses 5, as well as an augmented reality camera, allow the surgeon to combine viewing three-dimensional models of the patient’s anatomy and the surgical field. In contrast to the augmented reality camera, which adds an image of the surgical field to the viewing window of three-dimensional models, augmented reality glasses allow you to add an image of three-dimensional models in the field of view of a surgeon looking at the operating field. Augmented reality glasses 5 (Fig. 6) consist of a headband and a control unit. Electronic imaging modules and transparent combiners are fixed on the headband, combining light rays coming from the outside with the rays formed by the augmented reality glasses modules 5. The brightness and color reproduction of the image formed by the glasses modules are possible using the control unit. Glasses work in stereoscopic mode. Glasses 5 are equipped with a set of spherical reflective markers that allow software based on the image from stereo camera 3 to determine the position of the surgeon's head in the coordinate system of the stereo camera. The transformation matrix obtained as a result of registration allows you to convert the coordinates of the head and the direction of the surgeon’s gaze from the coordinate system of the stereo camera to the coordinate system of the tomograph, in which all three-dimensional models of the patient’s anatomy are built, and display these models in augmented reality glasses 5.

The proposed technical solution allows to reduce the time of the operation by speeding up the search for anatomical structures of interest and reducing the invasiveness of the operation by reducing the area of surgical access to the minimum required size and by searching for the anatomical structures of interest without damaging the tissues. As a result, the number of complications decreases and the time for patient rehabilitation after surgery is reduced.

Claims (2)

1. The method of preparation and execution of a surgical operation using augmented reality, including the stages of planning a surgical operation, surgical navigation and surgical intervention using augmented reality, moreover, at the stage of planning a surgical operation, the patient undergoes computer or magnetic resonance imaging and form a three-dimensional raster image of an individual anatomy the patient, which is transferred to the computer complex equipment for surgical operations using augmented reality, characterized in that at the stage of surgical navigation, they perform the contour construction and three-dimensional reconstruction of all anatomical structures of interest to the surgeon in the upcoming operation by setting three key points on the anatomical landmarks visible on a computer screen in the form of a three-dimensional model and also visible or tangible on the patient’s body, the points being chosen with the possibility of forming a triangle, after which the path and safe limits x rurgic access, determine the coordinate transformation matrix between the coordinate system of the stereo camera of the complex and the coordinate system of the tomograph in which the patient was diagnosed by setting the tip of the navigation pointer of the complex on the patient’s body with the same three points and in the same sequence as in the anatomical model, and fixing after the installation of three key points, if necessary, additional points are located on the same anatomical surface, after which starts the process of registering points with points on the surface of three-dimensional models of the patient’s anatomy, while the 3D model of the navigation pointer is additionally displayed on the computer screen, while the position and orientation of the three-dimensional model of the navigation pointer relative to the patient’s anatomy models corresponds to the physical position of the pointer relative to the patient’s anatomical surface, at the stage of surgical intervention use a navigation pointer to search for anatomical structures of interest, access points to them, the directions of their location relative to the access point, the distance to them, as well as to limit the area of surgical access, while focusing on the image on a computer screen or in augmented reality glasses, a navigation pointer is set in the surgical access area so that the anatomical of interest the structure was on the line of continuation of the pointer, while the screen displays the distance to the anatomical structure in millimeters, and to limit the area of surgical access, Based on the image on a computer screen or in augmented reality glasses, the navigation pointer is moved so that the continuation line of the pointer moves along the contour of the anatomical structure of interest, the pointer is moved along the projection line of the anatomical structure of interest on the body surface and the area of the upcoming surgical access is outlined, after which they perform surgery, during which, if necessary, establish a new access point and adjust the access area. 2. A set of equipment for the implementation of a surgical operation using augmented reality, comprising a camera unit mounted on the surgical field and including an augmented reality camera and a ToF camera, a stereo camera operating in the infrared wavelength range, augmented reality glasses, containing a control panel associated with a computer, and markers, characterized in that the stereo camera is mounted in such a way that markers made of spherical and reflective, located on the camera unit, navigation pointer, augmented reality glasses and the base marker of the coordinate system, and the configuration of the markers on each of them is different from the others, the base marker of the coordinate system is fixed on the skull clamp or operating table, and the computer is equipped with a foot controller in the form of a block with pedals .

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