Augmented Reality and Image-Guided Robotic Liver Surgery

Abstract

Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses.

The Role of ICG in Robot-Assisted Liver Resections

“…To perform parenchymal-sparing resections, as well as to achieve intraoperative security and R0 resections, the use of an IOUS is highly recommended when performing liver surgery [ 1 , 9 , 45 ]. While IOUS comes with known limitations, intraoperative ICG staining may help confirm real-time visualization of tumor and resection margins.…”

Advances in the surgical treatment of liver cancer

“…It may be useful at ensuring an appropriate margin from the tumor and avoiding unnecessary damage to the vasculature. Novel techniques may not necessarily be needed by already skilled liver surgeons but may be beneficial for less experienced ones (53).…”

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

“…As mentioned above, robot-assisted surgery offers the opportunity to integrate information from new imaging techniques [ 57 ]. Using a combination of pre-operative and intraoperative imaging is a novel approach, and some investigators have begun to incorporate artificial intelligence techniques in new concepts of robot-assisted hepatic surgery [ 60 ]. Imaging technologies such as Augmented Reality have been integrated to assist the surgeon and limit the intrinsic drawbacks of minimally invasive resections, such as the lack of tactile feedback, which can hamper numerous procedures during liver resection.…”

“…Arteries, veins, and biliary structures, present as thickened fibrotic sheaths, and the lack of haptic feedback when using a robot can fail to orient surgeons during dissection, which can result in vascular injuries. Augmented reality is effective in preoperatively planning strategy through 3D rendering and intraoperatively, targeting the lesion and resection margins [ 60 ]. Augmented reality-based intraoperative reconstructions and tracking systems may be used to map resection planes and show vascular structures during liver transection [ 60 ].…”

“…Augmented reality is effective in preoperatively planning strategy through 3D rendering and intraoperatively, targeting the lesion and resection margins [ 60 ]. Augmented reality-based intraoperative reconstructions and tracking systems may be used to map resection planes and show vascular structures during liver transection [ 60 ]. This is clearly just the beginning of efforts to integrate imaging technology into robot-assisted surgery.…”