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Recent years have seen revolutionary changes in CAS field thanks to the introduction of advanced Augmented Reality technologies. In this brief will be presented the overall study carried out in order to develop an AR application to support the doctor during the surgery. It will be described the way the surgeon can perform a more accurate diagnosis by using not just the traditional bidimensional grey-scale CT/MRI images, but also a more realistic three-dimensional marker-based visualization of the patient’s organs. Specific focus will be given to the extremely beneficial way the surgeon can interact with this kind of digital information in the operating room. It will be presented a highly innovative gesture-control device which allows the doctor to interact with IT equipment in a touchless and as natural as possible way, without coming into contact with it or interrupting the surgery, thus preserving the surgical environment from the danger of contamination.

Maxillo-facial surgery is a surgical field where surgical planning and navigation tools are commonly used but there is still a visualization gap among planned surgical activities and those in the operating room. We propose an Augmented Reality platform that includes a planning module and a drill guidance system. Some laboratory tests on 3D printed mandibles have been carried out in order to evaluate the system guidance uncertainty with different sets of fiducial points. The obtained mean value of guidance uncertainty has been of 1.37 mm when 2 anatomical points and 3 implanted screws were used and 1.43 mm when 5 anatomical points were used. The use of three fixed screws reduces the system mean guidance uncertainty and surgeons judged the augmented reality technology helpful in this kind of surgical procedures.

Minimally invasive surgery offers advantages that make it the best choice for many diseases. The Virtual Reality technology gives a great support to this kind of surgical procedures through medical image processing and visualization, 3D organ's reconstruction and intra-operative surgical guidance. In this paper is presented an advanced visualization and navigation system and the surgeon has the possibility to visualize both the traditional patient information, as the CT image set, and a 3D model of the patient's anatomy built from this. Two different visualization modalities are available in real time and dynamically. According to the surgeon needs, it is possible to obtain the automatic reslicing of the orthogonal planes in order to have an accurate visualization of the 3D model and slices exactly next to the actual position of the surgical instrument tip. In addition, it is possible to activate the clipping modality that allows cutting the 3D model in correspondence of a chosen visualization plane. The system can be used as support for the diagnosis, for the surgical preoperative planning and also for an image-guided surgery.