# Improving Surgical Situational Awareness with Signed Distance Field: A Pilot Study in Virtual Reality

arXiv: https://arxiv.org/abs/2303.01733 · HTML: https://mlsanity.com/paper/2303.01733/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 3 Mar 2023.

## Built on by (most cited first, 2 of 2)

- [Realistic Data Generation for 6D Pose Estimation of Surgical Instruments](https://mlsanity.com/paper/2406.07328/) (2024)
- [AutoCam: Hierarchical Path Planning for an Autonomous Auxiliary Camera in Surgical Robotics](https://mlsanity.com/paper/2505.10398/) (2025)

## Abstract (arXiv)

The introduction of image-guided surgical navigation (IGSN) has greatly benefited technically demanding surgical procedures by providing real-time support and guidance to the surgeon during surgery. To develop effective IGSN, a careful selection of the surgical information and the medium to present this information to the surgeon is needed. However, this is not a trivial task due to the broad array of available options. To address this problem, we have developed an open-source library that facilitates the development of multimodal navigation systems in a wide range of surgical procedures relying on medical imaging data. To provide guidance, our system calculates the minimum distance between the surgical instrument and the anatomy and then presents this information to the user through different mechanisms. The real-time performance of our approach is achieved by calculating Signed Distance Fields at initialization from segmented anatomical volumes. Using this framework, we developed a multimodal surgical navigation system to help surgeons navigate anatomical variability in a skull base surgery simulation environment. Three different feedback modalities were explored: visual, auditory, and haptic. To evaluate the proposed system, a pilot user study was conducted in which four clinicians performed mastoidectomy procedures with and without guidance. Each condition was assessed using objective performance and subjective workload metrics. This pilot user study showed improvements in procedural safety without additional time or workload. These results demonstrate our pipeline's successful use case in the context of mastoidectomy.