First evaluation of augmented and mixed reality in open liver surgery

Area of Science:

• Hepatobiliary Surgery
• Medical Technology
• Surgical Navigation

Background:

• Liver tumor treatment demands precise spatial understanding of anatomy.
• Traditional 2D imaging presents cognitive challenges for surgeons.
• Mixed Reality (MXR) offers immersive visualization to aid spatial orientation.

Purpose of the Study:

• To evaluate the clinical feasibility, usability, and cognitive workload of an MXR platform for liver surgery.
• To assess the integration of MXR for preoperative planning and intraoperative navigation.
• To determine the impact of MXR on surgical decision-making and spatial understanding.

Main Methods:

• Retrospective analysis of quality assurance data from five patients undergoing open liver resection.
• Utilized CE-certified MXR (Microsoft HoloLens 2 with HoloCare Studio™) for 3D holographic visualization of patient-specific anatomy.
• Assessed cognitive workload using NASA Task Load Index (NASA-TLX) and usability via System Usability Scale (SUS).

Main Results:

• The MXR system demonstrated seamless integration in all cases.
• Improved tumor localization and understanding of vascular anatomy were observed.
• Low cognitive workload (NASA-TLX: 13.8 preop, 14.7 intraop) and excellent usability (SUS: 96.0 preop, 95.5 postop) were reported.

Conclusions:

• MXR integration is feasible and efficient in open hepatic surgery.
• The technology imposes minimal cognitive workload and is well-accepted by surgeons.
• MXR shows promise as a valuable tool in hepatobiliary surgery.