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Intraoperative support with three-dimensional holographic cholangiography in hepatobiliary surgery

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This study was performed to investigate the potential of intraoperative three-dimensional (3D) holographic cholangiography, which provides a computer graphics model of the biliary tract, with mixed reality techniques.


Two patients with intraductal papillary neoplasm of the bile duct were enrolled in the study. Intraoperative 3D cholangiography was performed in a hybrid operating room. Three-dimensional polygon data using the acquired cholangiography data were installed into a head mount display (HoloLens; Microsoft Corporation, Redmond, WA, USA).


Upon completion of intraoperative 3D cholangiography, a hologram was immediately and successfully made in the operating room using the acquired cholangiography data, and several surgeons wearing the HoloLens succeeded in sharing the same hologram. Compared with usual two-dimensional cholangiography, this 3D holographic cholangiography technique contributed to more accurate reappearance of the bile ducts, especially the B1 origination site, and moving the hologram from the respective operators’ angles by means of easy gesture-handling without any monitors.


Intraoperative 3D holographic cholangiography might be a new next-generation operation-support tool in terms of immediacy, accurate anatomical reappearance, and ease of handling.

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Data availability

The current datasets are deposited in publicly available repositories (where available and appropriate).

Code availability

Not applicable.



Computer graphics


Mixed reality


Intraoperative cholangiography


Indocyanine green


Cone beam computed tomography


Head mount displays


Optical see-through


Magnetic resonance cholangiopancreatography


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Authors and Affiliations



Yu Saito MD, PhD, FACS, participated in the research design, performance of the research, data analysis, and writing of manuscripts. Maki Sugimoto MD, PhD, participated in the research design and performance of the research. Yuji Morine MD, PhD, FACS, participated in the performance of the research. Satoru Imura MD, PhD, FACS, participated in the performance of the research. Tetsuya Ikemoto MD, PhD, FACS, participated in the performance of the research. Shinichiro Yamada MD, PhD, FACS, participated in the performance of the research. Mitsuo Shimada MD, PhD, FACS, participated in the critical comments and administrative support.

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Correspondence to Yu Saito.

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The authors declare no competing interests.

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The study was approved by Tokushima University Hospital ethics committee and with the approval of corresponding regulatory agencies, and all the experiments were carried out in accordance with the approved guidelines (Tokushima Clinical Trial Management System Number; 3294). Meanwhile, all the patients involved in the study signed the informed consent form and agreed to participate.

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Saito, Y., Sugimoto, M., Morine, Y. et al. Intraoperative support with three-dimensional holographic cholangiography in hepatobiliary surgery. Langenbecks Arch Surg 407, 1285–1289 (2022).

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