Practical use of a 3D head-mounted display in hybrid robotic and transperineal rectal surgery

With the widespread adoption of robotic surgical platforms, a hybrid approach for rectal cancer combining abdominal robotic surgery with transanal or transperineal total mesorectal excision (TME) technique has been introduced. However, in this two-team approach, the docked robotic arms extend over the patient and frequently obstruct the transanal surgeon's line of sight, making it difficult to view the operative monitor and causing excessive cervical rotation and neck strain. To address this ergonomic issue, we implemented a three-dimensional head-mounted display (3D-HMD) using 3D View Vision system (FA. System Engineering Co., Ehime, Japan), which provides stereoscopic, high-definition visualization regardless of head position.

The system offers 3840 × 1080-pixel resolution, minimal latency, light weight, and seamless switching between robotic and transperineal views, and images from both 2D and 3D endoscopes can be converted to stereoscopic 3D. The transperineal surgeon wore the 3D-HMD during transperineal TME and lateral pelvic lymph node dissection in coordination with the abdominal robotic team. Using this set-up, five abdominoperineal resections and one total pelvic exenteration were performed, all with bilateral lateral pelvic lymph node dissection.

The median operating time was 530 min, with a median 3D-HMD usage of 315 min. The surgeon subjectively reported no cervical discomfort, visual disturbance, or device-related fatigue, and the visual field remained stable throughout the prolonged procedures.

The integration of a 3D-HMD into a hybrid two-team approach was feasible and subjectively well tolerated, providing high-resolution stereoscopic visualization without reported cervical discomfort.