3D mixed-reality visualization of medical imaging data as a supporting tool for innovative, minimally invasive surgery for gastrointestinal tumors and systemic treatment as a new path in personalized treatment of advanced cancer diseases

Abstract

Background The purpose of this study was to investigate the potential of a combination of 3D mixed-reality visualization of medical images using CarnaLife Holo (MedApp, Poland) system as a supporting tool for innovative, minimally invasive surgery/irreversible electroporation—IRA, Nano-Knife), microwave ablation (MWA)/for advanced gastrointestinal tumors. Eight liver and pancreatic tumor treatments were performed. In all of the patients undergoing laparoscopy or open surgery volume and margin were estimated by preoperative visualization. In all patients, neoplastic lesions were considered unresectable by standard methods. Methods Preoperative CT or MRI were transformed into holograms and displayed thanks to the HoloLens 2. During operation, the surgeon’s field of view was augmented with a 3D model of the patient’s relevant structures. Results The intraoperative hologram contributed to better presentation of tumor size and locations, more precise setting of needles used to irreversible electroporation and for determining ablation line in case of liver metastases. Surgeons could easily compare the real patient's anatomy to holographic visualization just before the operations. Conclusions The combination of 3D mixed-reality visualization using CarnaLife Holo with IRA, MWA and next systemic treatment (chemotherapy) might be a new way in personalized treatment of advanced cancers.

Mixed Reality in Modern Surgical and Interventional Practice: Narrative Review of the Literature

“…Within oncological surgery, MR has been applied for preoperative planning of minimally invasive electroporation and microwave ablation for advanced gastrointestinal tumors of hepatic origin. It improved remote and hospital-based analysis of patient-specific anatomy and optimized surgical approach [ 10 ]. MR-guided surgical planning for liver resection refined understanding of hepatic vascular anatomy and tumor location, improving accuracy of resection while preserving a larger residual liver volume [ 11 ].…”

“…Within oncological surgery, one study reported a reduction in operating time by a third and improved perceived surgical precision during minimally invasive resection of gastrointestinal tumors [ 10 ]. Moreover, MR enabled better identification of dissection lines and understanding of vascular anatomy in hepatic surgery, facilitating segmental resection [ 38 , 39 ].…”

The intraoperative use of augmented and mixed reality technology to improve surgical outcomes: A systematic review

“…Wierzbicki et al. performed a series of MR‐guided resections of liver and pancreas tumours, with an average operative duration of 62.5 ± 21.2 min and inpatient stay of 5.5 ± 1.5 days, and no reported complications 74 …”

“…performed a series of MR-guided resections of liver and pancreas tumours, with an average operative duration of 62.5 � 21.2 min and inpatient stay of 5.5 � 1.5 days, and no reported complications. 74 Tang et al reported a case of AR-guided open hilar cholangiocarcinoma resection with left hepatectomy, following which the patient was without complications. 75…”

Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects

“…Most of the studies [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ] in this review are focused on application of HoloLens 2 in surgical navigation in the operating room and in the emergency department. The use of the AR/MR based system in this context provided the user with computer-generated information superimposed to real-world environment and improved accuracy, safety and efficacy of surgical procedures [ 86 ].…”