Application of Real‐Time Augmented Reality Laparoscopic Navigation in Splenectomy for Massive Splenomegaly

Abstract

Objectives To evaluate the clinical impact and technical feasibility of augmented reality laparoscopic navigation (ARLN) system in laparoscopic splenectomy for massive splenomegaly. Methods The clinical data of 17 consecutive patients who underwent laparoscopic splenectomy using ARLN (ARLN group) and 26 patients without ARLN guidance (Non‐ARLN group) between January 2018 and April 2020 were enrolled. Propensity score matching (PSM) analysis was performed between the patients with and without ARLN guidance at a ratio of 1:1. Results Mean intraoperative blood loss was significantly lower in the ARLN‐group than in the Non‐ARLN group (306.6 ml vs. 462.6 ml, p = 0.047). All the patients in the ARLN‐group achieved successful splenic artery dissection, while surgical success was achieved in 12 patients in the Non‐ARLN group (p = 0.044). Postoperative hospital stay was significantly longer in the Non‐ARLN group (3.8 days vs. 4.5 days, p = 0.040). Conclusions ARLN can provide feasible and accurate intraoperative image guidance, and it could be helpful in the performance of laparoscopic splenectomy for massive splenomegaly.

The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review

“…In a prospective cohort study comparing AR‐guided to standard laparoscopic splenectomy, 17 patients undergoing AR‐guided surgery had significantly lower intraoperative blood loss (306.6 ± 175.0 ml vs. 462.6 ± 300.5 ml, p = 0.047) and shorter inpatient stays (3.8 ± 1.3 days vs. 4.5 ± 2.6 days, p = 0.04) while operative times and rates of postoperative complications were not significantly different between the two groups 66 …”

“…However, in three other studies, AR systems showing only anatomy showed reduced blood loss with unchanged operative duration 50,60,66 . It might have been in these studies that AR guidance principally reduced error (and thereby tissue injury and blood loss) and had a lesser or no effect on speed (and operative duration), or that its potential effect on speed was negated by inexperience with new systems.…”

“…The duration of a patient's inpatient stay is a result of many factors including their preoperative status and those factors described above: operative duration, operative blood loss and postoperative complications. Four studies, in pedicle screw fixation, laparoscopic hepatectomy, laparoscopic splenectomy and thoracoscopic surgery found that AR significantly reduced the duration of inpatient care 50,60,66,105 . In all of these, shortened inpatient stays were observed alongside reduced intraoperative blood loss.…”

“…Seven studies, all in percutaneous surgery, were identified in which AR and MR significantly reduced blood loss 16,50,60,66,86,87,105 . Rather than spine surgery, most were in organ resection via laparoscopic, robotic or thoracoscopic technique.…”

A high-speed hyperspectral laparoscopic imaging system

“…The field of laparoscopic imaging has evolved much through the efforts of various research groups in many areas, leading to advanced state-of-the-art systems including augmented/mixed reality capable systems [10][11][12][13][14][15][16][17][18][19][20][21][22][23], which further subdivides into hyperspectral imaging (HSI) systems [24][25][26][27][28][29][30][31][32][33][34][35] and combinatory operative imaging systems [36][37][38], dual/multi modal systems [39][40][41][42][43], and high speed hyperspectral systems [44]. Each system seeks to improve the current capabilities of surgical imaging in laparoscopic procedures by providing additional diagnostic data as well as methods for interpreting that data.…”