F.Volonte, P.Bucher, F.Pugin, A.Carecchio, M.Sugimoto, O.Ratib, P.Morel "Mixed reality for laparoscopic distal pancreatic resection"

Laparoscopic distal pancreatectomy may be a challenging procedure because of the inability for the surgeon to touch structures hidden in the pancreatic tissue. Moreover, the anatomy of the area requires extra care because a major local bleeding would quickly perturb the laparoscopic technique. We brought in the operating room a new tool that increased perception of the surgeon in the operative field superimposing 3D images obtained from simple CT scan with a beamer.
Our patient had a small nodule in the tail of the pancreas with a PET CT hot spot on the surface of the right colon, not visible at colonoscopy, possibly a tumor implant. For a precise localization, the two lesions were plotted (Osirix) with different colors on the CT images and therefore safely isolated on 3D reconstructions. These images were then projected on the patient himself with a beamer fixed to the operating table. This technique of augmented reality enabled us to accurately locate anatomical landmarks on the surface of the patient and plan the lesions resection. The instruments have been placed with greater reliability knowing exactly where the lesions were located. The 3D image was also displayed on a large screen positioned at the left of the surgeon.
The nodule on the surface of the right flank was resected in the middle of the fatty tissue overlying the colon thanks to the directives given by the superposition of reconstructed images. The frozen section confirmed the presence of a fibrous and inflammatory response without signs of malignancy. The pancreatic nodule clearly identified and resected. The splenic vessels spared because of their easier spatial identification.
The overlay of virtual images on the real world is a valuable aid in laparoscopic and robotic interventions. These techniques remove the operator from the operating field, by interposing a mechanical instrument or a digital interface between the patient and the surgeon. Overlaying 3D images on the patient himself in order to accurately locate structures and displaying the same images beside the laparoscopic video gives the surgeon a new perception of the operating field and a real advantage compared to simple laparoscopy. This technique substitute to the lack of sense of touch that is proper to the laparoscopic technique.

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