Laparoscopic Liver Resection with Augmented Reality: A Preclinical Experience

Introduction: Intraoperative imaging, such as ultrasound, provides subsurface anatomical information not seen by standard laparoscopy. Currently, information from the two modalities may only be integrated in the surgeon's mind, an often distracting and inefficient task. The desire to improve intraoperative efficiency has guided the development of a novel, augmented reality (AR) laparoscopic system that integrates, in real time, laparoscopic ultrasound (LUS) images with the laparoscopic video. This study shows the initial application of this system for laparoscopic hepatic wedge resection in a porcine model. Materials and Methods: The AR system consists of a standard laparoscopy setup, LUS scanner, electromagnetic tracking system, and a laptop computer for image fusion. Two liver lesions created in a 40-kg swine by radiofrequency ablation (RFA) were resected using the novel AR system and under standard laparoscopy. Results: Anatomical details from the LUS were successfully fused with the laparoscopic video in real time and presented on a single screen for the surgeons. The RFA lesions created were 2.5 and 1cm in diameter. The 2.5cm lesion was resected under AR guidance, taking about 7 minutes until completion, while the 1cm lesion required 3 minutes using standard laparoscopy and ultrasound. Resection margins of both lesions grossly showed noncoagulated liver parenchyma, indicating a negative-margin resection. Conclusions: The use of our AR system in laparoscopic hepatic wedge resection in a swine provided real-time integration of ultrasound image with standard laparoscopy. With more experience and testing, this system can be used for other laparoscopic procedures.