The technology of augmented and mixed reality (AR/MR) is useful in various areas of modern surgery. We considered the use of augmented and mixed reality technologies as a method of preoperative planning and intraoperative navigation in abdominal cancer patients. Practical use of AM/MR raises a range questions, which demand suitable solutions. The difficulties and obstacles we encountered in the practical use of AR/MR are presented, along with the ways we chose to overcome them. The most demonstrative case is covered in detail. The three-dimensional anatomical model obtained from the CT scan needed to be rigidly attached to the patient’s body, and therefore an invasive approach was developed, using an orthopedic pin fixed to the pelvic bones. The pin is used both similarly to an X-ray contrast marker and as a marker for augmented reality. This solution made it possible, not only to visualize the anatomical structures of the patient and the border zone of the tumor, but also to change the position of the patient during the operation. In addition, a noninvasive (skin-based) marking method was developed that allows the application of mixed and augmented reality during operation. Both techniques were used (8 clinical cases) for preoperative planning and intraoperative navigation, which allowed surgeons to verify the radicality of the operation, to have visual control of all anatomical structures near the zone of interest, and to reduce the time of surgical intervention, thereby reducing the complication rate and improving the rehabilitation period.

Surgical treatment of locally spread tumors of pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to a successful and safe surgical intervention is careful planning and intraoperative navigation, including the use of augmented reality technology. The study presents the experience in the clinical testing of augmented reality technology in the surgical treatment of 11 patients. The paper also described the main stages of the algorithm. Radical operations with intraoperative application of augmented reality technology were performed in eight patients with favorable outcomes. One patient underwent palliative intervention, and two patients did not undergo surgery. In the eight patients who underwent surgery, the median operation time was 202.5 (117.5282.5) min, the median volume of blood loss was 300 (187.5625) mL, and the median duration of hospital stay was 21 (17.7527.75) days. Three patients (37.55%) developed complications, namely, necrosis of the perineal edges of the wound, ascending pyelonephritis, and intrahospital pneumonia. No hospital fatality has been registered. In the postoperative morphological examination, a negative peripheral resection boundary (R0 resection) was achieved in all patients. Subsequently, these patients were referred for dynamic monitoring and systemic antitumor therapy. The application of an augmented reality algorithm in the surgical treatment of primary and recurrent pelvic tumors is feasible and reproducible in clinical practice. Augmented reality technology, with its innovative nature and obvious advantages, opens up certain prospects for improving the results of multivisceral resections of pelvic organs; however, further study and implementation in clinical practice are necessary.

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