Towards cybernetic surgery: robotic and augmented reality-assisted liver segmentectomy

Area of Science:

• Surgical Navigation
• Medical Imaging
• Robotic Surgery

Background:

• Augmented reality (AR) integrates preoperative 3D models with real-time patient images to reveal hidden anatomical details during surgery.
• AR enables preoperative planning and enhances surgical dissection safety, particularly in procedures like robotic hepatectomy.

Purpose of the Study:

• To evaluate the utility of augmented reality (AR) as a navigation tool in fully robotic hepatic segmentectomy.
• To assess the safety and efficacy of AR in visualizing critical vascular structures and guiding surgical resection.

Main Methods:

• Three patients underwent robotic hepatic segmentectomy using AR. A 3D virtual anatomical model was created from CT scans and processed for surgical planning, including simulation of pneumoperitoneum effects.
• The virtual model was superimposed onto the operative field, with manual, real-time registration of virtual and real images by a computer scientist.

Main Results:

• Two segmentectomy V and one segmentectomy VI were successfully performed using AR-assisted robotic surgery.
• AR facilitated precise identification of all major vascular structures, eliminating the need for hepatic pedicle clamping and ensuring correct remnant liver vascularization.
• All resections had negative margins, and patients experienced uneventful postoperative periods without transfusions. The AR system setup took approximately 8 minutes.

Conclusions:

• Augmented reality (AR) serves as a valuable navigation tool in robotic hepatectomy.
• AR can improve the precision and safety of surgical resections by enhancing the visualization of critical anatomy.