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Typically, surgeons study computed tomography (CT) and magnetic resonance imaging (MRI) data before surgery. This allowes to evaluate defferent variants of the blood vessels architecture and other anatomical features of the location of organs in each specific case. Planning the operation allows to reduce the risk of intra- and postoperative complications. However, there are a number of studies that show the limited ability of the surgeon to obtain an accurate understanding of the anatomical relationships of organs in the analysis of 2D images. The problem of effective interpretation of anatomy exists both in abdominal surgery and in urology when performing kidney resections of varying complexity. In order to improve the quality of interpretation of 2D images and a more accurate assessment of the scope and features of the planned operation, it was proposed to use 3D printing based on CT and MRI data. However, the application of this technology is time consuming, significantly increases financial costs and has limited availability. With the development of computer technologies and visualization methods, the idea of using the so-called augmented reality (AR) appeared in the planning of surgical interventions, as well as for the intraoperative orientation of the surgeon. Augmented reality makes it possible to create a high-quality virtual 3D model of the anatomy of a particular patient. The surgeon has the ability to view and control the AR model using a head-mounted display. It should be noted that the CT data used to create the AR models included 3D visualization of the rotation of the kidneys and the abdominal vasculature. These 3D images can be rotated horizontally, but they cannot be reconstructed and manipulated like AR models, which is also an advantage of using the technology. The use of AR models in urology has improved surgeons' understanding of the kidney anatomy of a particular patient and contributed to changing the original kidney resection plan in some cases. In abdominal surgery, the use of AR also takes place. Publications on this theme have been found since 2017 and belong to a group of authors from Germany and the USA.
The purpose of the study was to evaluate the possibilities of using augmented reality technology in operations on the abdominal organs.
Methods. The CT data obtained during the examination of the patient before surgery were processed in a computer program in order to obtain polysegmental models. The data obtained after processing were used in the HLOIA© software to create a virtual volumetric model of the organ, taking into account the anatomical features of a particular patient.
Prior to the operation and intraoperatively, second-generation Hololens virtual reality glasses from Microsoft (Seattle, Washington, USA) with the HLOIA© system implemented in them were used. From December 2021 to January 2022, three surgical interventions were performed using AR technology. The scope of operations was laparoscopic echinococcectomy with resection of the 5th and 6th liver segments for residual echinococcosis; laparoscopic pancreatoduodenal resection for pancreatic cancer and laparoscopic cystectomy of the mesentery of the small intestine.
Results. The use of AR technology did not significantly affect the planning of the scope of the operation, and also did not significantly influenced the time of the operations performed. At the same time, the use of AR facilitated the surgeon's orientation during liver resection and manipulation near the vascular-secretory elements for residual liver echinococcosis. When performing laparoscopic pancreatoduodenal resection, the use of AR contributed to a better understanding of the anatomy when creating a tunnel while the departing from the superior mesenteric and splenic veins, as well as determining the level of intersection of the pancreatic parenchyma. When removing a cystic tumor of the mesentery of the small intestine, the use of AR did not provide tangible advantages over the standard preoperative examination and planning of the scope of the operation. Nonetheless, after viewing the AR model, the surgeon became more confident in the anatomy of the vessels and the relationship of the removed tumor (or hydatid cyst) with vascular structures.
Conclusion. Preoperative and intraoperative viewing of interactive augmented reality models can increase the surgeon's confidence and improve understanding of the anatomy, especially in complex cases and when planning non-standard surgical interventions, optimize the operative approach, and in some cases change the initial operation plan. At the same time, further research is required to clarify the areas of application of augmented reality models and the possible development of a protocol for their use in abdominal and, in particular, hepatopancreatobiliary surgery.