Holographic Augmented Reality for DIEP Flap Harvest

Abstract

Background: During a deep inferior epigastric perforator (DIEP) flap harvest, the identification and localization of the epigastric arteries and its perforators are crucial. Holographic augmented reality is an innovative technique that can be used to visualize this patient-specific anatomy extracted from a computed tomographic scan directly on the patient. This study describes an innovative workflow to achieve this. Methods: A software application for the Microsoft HoloLens was developed to visualize the anatomy as a hologram. By using abdominal nevi as natural landmarks, the anatomy hologram is registered to the patient. To ensure that the anatomy hologram remains correctly positioned when the patient or the user moves, real-time patient tracking is obtained with a quick response marker attached to the patient. Results: Holographic augmented reality can be used to visualize the epigastric arteries and its perforators in preparation for a deep inferior epigastric perforator flap harvest. Conclusions: Potentially, this workflow can be used visualize the vessels intraoperatively. Furthermore, this workflow is intuitive to use and could be applied for other flaps or other types of surgery.

Mixed Reality in Modern Surgical and Interventional Practice: Narrative Review of the Literature

“…After appropriate positioning was ensured, MR resulted in improved perceived reconstructive results compared to a conventional approach with transparent film guidance [ 47 ]. Application of MR during vascular flap transfers and reconstructions that require identification and preservation of target perforator vessels, such as deep inferior epigastric perforator flap reconstruction of breast tissue, resulted in improved localization of the target perforating vessels when compared to Doppler-ultrasound [ 48 ]. An encountered problem, however, was related to adequate depth perception of the target vessels, which was limited using MR [ 49 ].…”

Alternative imaging technologies for perforator mapping in free flap breast reconstructive surgery – A comprehensive overview of the current literature

“…Wesselius et al used the Microsoft HoloLens to visualize the epigastric arteries and its perforators in relation to the rectus abdominis muscle in preparation for a deep inferior epigastric perforator flap harvest. 79 A software application was developed to visualize the anatomy as a hologram and used abdominal nevi as natural landmarks. The three-dimensional holographic visualization provides an intuitive and strong perception of complex anatomy and can be used preoperatively to mark anatomic structures such as vessels on the patients, or intraoperatively to navigate.…”

Virtual Reality and Augmented Reality in Plastic and Craniomaxillofacial Surgery: A Scoping Review

“…Among the first were the Oculus Rift (Oculus VR, Menlo Park, CA, USA) and HoloLens (Microsoft Corporation, Redmond, WA), both of which were released in 2016 [ 4 ]. Commercial VR/AR platforms have proven to be fertile ground for video game companies, and these companies have built standardized software platforms for VR/AR systems; some, such as Unreal Engine (Epic Games, Cary, NC, USA) and Unity (Unity Technologies, San Francisco, CA, USA), have become the basis for numerous other software products [ 4 , 12 , 13 , 14 , 15 , 16 ].…”

“…Innovations in VR and AR software and hardware have broadened accessibility to these platforms and made them more widespread than ever. In addition to novel medical applications that have begun to utilize mainstream devices such as the HoloLens and software platforms based on major software templates, powerful new smartphones have arisen as a growing platform for AR both within and outside of the clinical setting [ 12 , 13 , 14 , 15 , 16 , 26 , 27 , 28 , 29 , 30 ]. VR/AR also has the capacity to synergize with existing “high tech” surgical aids such as 3D printing technology [ 24 , 31 ].…”