Toward augmented reality in laparoscopic liver surgery using electromagnetic tracking: a clinical feasibility study

Area of Science:

• Minimally Invasive Surgery
• Surgical Navigation
• Medical Imaging

Background:

• Augmented reality (AR) offers potential for improved visualization and precision in laparoscopic liver surgery.
• Accurate registration and motion compensation are key challenges for clinical AR implementation.
• This study adapted electromagnetic (EM)-tracked navigation for the laparoscopic setting, integrating AR to assess feasibility and accuracy.

Purpose of the Study:

• To translate EM-tracked navigation to laparoscopic liver surgery.
• To incorporate AR visualization into the surgical workflow.
• To evaluate the clinical feasibility and accuracy of this AR navigation system.

Main Methods:

• Adapted an open navigation workflow using EM tracking for instruments (pointer, LUS probe, laparoscope).
• Developed and tested four AR visualization modes ex vivo.
• Conducted a prospective feasibility study in patients undergoing laparoscopic liver resection, including sensor attachment, landmark-based registration, and intraoperative AR display.

Main Results:

• Robust tracking performance achieved for all laparoscopic instruments.
• Surgeons identified tumors, hepatic veins, and portal veins as critical for AR visualization.
• The complete AR workflow was successful in 13 of 14 procedures with a mean target registration error of 6.3 mm.

Conclusions:

• EM-tracked AR navigation is feasible for laparoscopic liver surgery.
• The system enables organ tracking and local motion compensation, aiding intraoperative orientation.
• This approach may enhance tumor localization and improve outcomes in minimally invasive liver resections.