Intraoperative 3D Hologram Support With Mixed Reality Techniques in Liver Surgery

An intra-operative 3D hologram with mixed reality techniques contributed to “last-minute simulation”, not for “navigation” in liver surgery. This intra-operative hologram might be a new next-generation operation-supportive tool in terms of spatial awareness, sharing, and simplicity.

Objective
The aim of this study was to investigate the potential of an intra-operative 3D hologram, which was a computer graphics (CG) model liver, with mixed reality (MR) techniques in liver surgery.
Summary Background Data
The merits for the application of a hologram for surgical support are: 1) no sterilized display monitor; 2) better spatial awareness; and 3) 3D images shared by all the surgeons.
Methods
3D polygon data using pre-operative computed tomography (CT) data was installed into head mount displays, HoloLens (Microsoft Corporation, Redmond, WA).
Results
In a Wi-Fi-enabled operative room, several surgeons wearing HoloLens succeeded in sharing the same hologram and moving that hologram from respective operators’ angles by means of easy gesture-handling without any monitors. The intra-operative hologram contributed to better imagination of tumor locations, and for determining the parenchymal dissection line in the hepatectomy for the patients with more than twenty (20) multiple colo-rectal liver metastases (CRLMs). In another case, the hologram enabled a safe Gliisonean pedicle approach for hepato-cellular carcinoma (HCC) with a hilar anatomical anomaly. Surgeons could easily compare the real patient’s anatomy and that of the hologram just before the hepatic hilar procedure.
Conclusions
This initial experience suggested that an intra-operative hologram with MR techniques contributed to “last-minute simulation”, not for “navigation”. The intra-operative hologram might be a new next-generation operation-supportive tool in terms of spatial awareness, sharing, and simplicity.