Related Experiment Video
Updated: Jun 22, 2026
Pioneering Patient-Specific Approaches for Precision Surgery Using Imaging and Virtual Reality
Published on: April 5, 2024
Augmented reality: a new tool to improve surgical accuracy during laparoscopic partial nephrectomy? Preliminary in
Dogu Teber1, Selcuk Guven, Tobias Simpfendörfer
1Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heidelberg, Germany.
Background:
Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique.
Objective:
To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN).
Design, Setting, And Participants:
Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN.
Interventions:
Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon.
Measurements:
The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo.
Results And Limitations:
The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases.
Conclusions:
This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures.
