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First evaluation of augmented and mixed reality in open liver surgery
Wolfram Lamadé1,2, Philipp C B Munk1,3, Marcus Ritter1,2
1Ruprecht-Karls Universität Heidelberg, Heidelberg, Germany.
Background:
This study aimed to evaluate the clinical feasibility, usability, and cognitive workload of a certified mixed reality (MXR) platform for preoperative planning and intraoperative navigation in liver surgery. Curative treatment of liver tumors requires precise comprehension of spatial relationships between tumors and vascular structures to achieve complete resection or ablation. Traditional two-dimensional imaging demands cognitive reconstruction of anatomy, posing challenges even for experienced surgeons. MXR technologies, such as Microsoft HoloLens 2 combined with HoloCare Studio™, enable immersive and interactive visualization that may improve spatial orientation, reduce cognitive load and support intraoperative decision-making.
Methods:
Routine quality assurance data from five male patients (mean age 61 years; range 44-80), collected during the clinical introduction of a CE-certified MXR device, undergoing open liver resection for hepatic malignancies were retrospectively evaluated. Patient-specific imaging, including three-phase computed tomography (CT) and, in one case, magnetic resonance imaging (MRI), was processed using HoloCare Studio™ (HoloCare Oslo) to create interactive 3D holograms of liver parenchyma, tumors, and vascular structures. These holograms were employed for both preoperative planning and intraoperative navigation through the HoloLens 2 headset. Cognitive workload was assessed using the NASA Task Load Index (NASA-TLX) and usability was measured using the System Usability Scale (SUS).
Results:
The HoloCare™ MXR system was seamlessly integrated into all five cases and improved tumor localization and understanding of vascular anatomy. Average NASA-TLX scores were 13.8 preoperatively and 14.7 intraoperatively, indicating low cognitive workload. Mean SUS scores were 96.0 preoperatively and 95.5 postoperatively, reflecting excellent usability.
Conclusion:
MXR integration into open hepatic surgery is feasible, fast, imposes minimal cognitive workload, and is well accepted. These findings support further evaluation of MXR as a valuable adjunct in hepatobiliary surgery.
