3D Reconstruction and Holographic XR Navigation in Robot-Assisted Sacrocolpopexy: A Report of Two Cases

Dissection at the sacral promontory during robot-assisted sacrocolpopexy (RSC) is technically demanding because of the proximity of major vascular structures and anatomical variability. We report two cases of RSC in which preoperative three-dimensional (3D) reconstructed imaging and holographic extended reality (XR) visualization were used for surgical planning and intraoperative navigation. In Case 1, 3D reconstructed imaging demonstrated a narrow vascular window anterior to L5, and mesh fixation was performed on the anterior longitudinal ligament over S1 under image-guided navigation. In Case 2, holographic XR visualization enabled preoperative distance assessment and identification of a vascularly safe region extending approximately 1.7 cm cranial to the sacral promontory, which was subsequently reproduced intraoperatively using the TilePro function on the da Vinci surgeon console. Both procedures were completed without vascular injury. Preoperative 3D reconstruction and holographic XR visualization may facilitate safer sacral promontory dissection during RSC by improving spatial understanding of patient-specific vascular anatomy and supporting patient-specific surgical planning and intraoperative navigation.