Abstract:Advances in perioperative care and surgical techniques have significantly improved the outcomes of liver resection during the last three decades. Liver surgery has inherent challenges, including difficult anticipation of complex and variable intrahepatic anatomy and the need for cognitive analysis by the surgeon to integrate preoperative imaging information into the operative field. Therefore, simulation and navigation techniques have been developed in this field.In preoperative simulation, three-dimensional (… Show more
“…There were 3 articles 1-3 regarding overall image-guided surgery using XR and the metaverse, and by department of surgery, the most common were 6 hepatobiliary [4][5][6][7][8][9] , and 6 orthopedic 10-15 , followed by 4 dental [16][17][18][19] , 3 digestive [20][21][22] , 2 otorhinolaryngeal [23][24] , 1 emergency 25 , 1 cardiac 26 , and 1 urologic surgery 27 .…”
Image-guided surgery using XR (extended reality: VR/AR/MR) technology has the potential to revolutionize the field of surgery by improving surgical accuracy, reducing procedure time, and enhancing communication and collaboration among the surgical team. We have developed a web-based system, Holoeyes, integrating XR, AI, and metaverse technology to facilitate holographic image-guided surgery. Holoeyes extracts organ shape data from CT or MRI scans and renders them with positional information to obtain X, Y, and Z coordinates. These coordinates are then converted into polygonal information for use in XR technology. The medical device, Holoeyes MD, was developed to create XR applications for surgical planning and navigation. It provides an immersive experience for the surgical team, improving both accuracy and efficiency. The integration of the metaverse in surgery allows for spatial conferencing and review of training, and the avatars replicate the hand and eye movements of the actual surgical procedure. Our Holoeyes system has already been utilized in numerous institutions for pre-and post-operative conferences, surgical planning, and surgical records, with multiple people wearing the headset and sharing information about the pathology, extent of resection, and layers of dissection from all directions. We conducted a systematic review of the literature to investigate the effectiveness of Holoeyes, focusing on the use of XR and the metaverse in surgery. We believe that Holoeyes has the potential to become an indispensable tool in the field of surgery, and we encourage further research and development in this field.
“…There were 3 articles 1-3 regarding overall image-guided surgery using XR and the metaverse, and by department of surgery, the most common were 6 hepatobiliary [4][5][6][7][8][9] , and 6 orthopedic 10-15 , followed by 4 dental [16][17][18][19] , 3 digestive [20][21][22] , 2 otorhinolaryngeal [23][24] , 1 emergency 25 , 1 cardiac 26 , and 1 urologic surgery 27 .…”
Image-guided surgery using XR (extended reality: VR/AR/MR) technology has the potential to revolutionize the field of surgery by improving surgical accuracy, reducing procedure time, and enhancing communication and collaboration among the surgical team. We have developed a web-based system, Holoeyes, integrating XR, AI, and metaverse technology to facilitate holographic image-guided surgery. Holoeyes extracts organ shape data from CT or MRI scans and renders them with positional information to obtain X, Y, and Z coordinates. These coordinates are then converted into polygonal information for use in XR technology. The medical device, Holoeyes MD, was developed to create XR applications for surgical planning and navigation. It provides an immersive experience for the surgical team, improving both accuracy and efficiency. The integration of the metaverse in surgery allows for spatial conferencing and review of training, and the avatars replicate the hand and eye movements of the actual surgical procedure. Our Holoeyes system has already been utilized in numerous institutions for pre-and post-operative conferences, surgical planning, and surgical records, with multiple people wearing the headset and sharing information about the pathology, extent of resection, and layers of dissection from all directions. We conducted a systematic review of the literature to investigate the effectiveness of Holoeyes, focusing on the use of XR and the metaverse in surgery. We believe that Holoeyes has the potential to become an indispensable tool in the field of surgery, and we encourage further research and development in this field.
“…Fluorescence staining will be helpful for complete resection of the Glisson system in di cult liver segments and high-quality exposure of the interwatershed veins. Adhere to the concept of river basin anatomical liver resection, implement the complete resection of the tumorbearing Glison system, and pursue long-term oncology and short-term perioperative e cacy, implement the consensus of international experts to the end, and carry out the MIALR concept to the extreme [22] .…”
Background
Laparoscopic hepatectomy requires precise techniques for safe completion. We have developed flow and modular strategies using visualization technology to improve surgical outcomes.
Methods
Between January 1, 2020, and January 1, 2022, 26 patients with tumors in segment 5 underwent Laparoscopic anatomical segment V resection at our institute using real-time ICG fluorescence mapping and ultrasound guidance. Their perioperative course and operative techniques were reviewed retrospectively.
Result
No cases required open surgery. Blood loss ranged from 10–600 ml, with a median operative time of 225 minutes (90–370). 26 out of 26 preoperative 3D simulations were accurately replicated during surgery, resulting in a 100% concordance rate. Postoperative mortality was absent, with 2 patients experiencing complications leading to a major morbidity rate of 4.6% based on the Clavien‒Dindo classification. Liver function remained stable before and after the operation.
Conclusion
Laparoscopic segment V resection for hepatocellular carcinoma using the Glissonian approach with indocyanine green dye and ultrasound guidance is safe, convenient, and feasible.
“…To calculate liver volume, CT volumetric analysis is an universally accepted method for estimating the FLR. Three-dimensional (3D) post-processing software enables semiautomatic FLR measurements using contrast-enhanced CT images [ 13 ]. Deep learning models have recently been developed for the automated or semi-automated segmentation of Couinaud liver segments and FLR for preoperative volumetric assessment [ 14 ].…”
Section: Role Of Volumetric Analysis Using Imaging For Predicting Phlfmentioning
Despite improvements in operative techniques and perioperative care, post-hepatectomy liver failure (PHLF) remains the most serious cause of morbidity and mortality after surgery, and several risk factors have been identified to predict PHLF. Although volumetric assessment using imaging contributes to surgical simulation by estimating the function of future liver remnants in predicting PHLF, liver function is assumed to be homogeneous throughout the liver. The combination of volumetric and functional analyses may be more useful for an accurate evaluation of liver function and prediction of PHLF than only volumetric analysis. Gadoxetic acid is a hepatocyte-specific magnetic resonance (MR) contrast agent that is taken up by hepatocytes via the OATP1 transporter after intravenous administration. Gadoxetic acid-enhanced MR imaging (MRI) offers information regarding both global and regional functions, leading to a more precise evaluation even in cases with heterogeneous liver function. Various indices, including signal intensity-based methods and MR relaxometry, have been proposed for the estimation of liver function and prediction of PHLF using gadoxetic acid-enhanced MRI. Recent developments in MR techniques, including high-resolution hepatobiliary phase images using deep learning image reconstruction and whole-liver T1 map acquisition, have enabled a more detailed and accurate estimation of liver function in gadoxetic acid-enhanced MRI.
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