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Intraoperative holographic image-guided surgery in a transanal approach for rectal cancer

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Abstract

Purpose

Urethral injury is one of the most important complications in transanal total mesorectal excision (TaTME) in male patients with rectal cancer. The purpose of this study was to investigate holographic image-guided surgery in TaTME.

Methods

Polygon (stereolithography) files were created and exported from SYNAPSE VINCENT, and then uploaded into the Holoeyes MD system (Holoeyes Inc., Tokyo, Japan). After uploading the data, the three-dimensional image was automatically converted into a case-specific hologram. The hologram was then installed into the head mount display, HoloLens (Microsoft Corporation, Redmond, WA). The surgeons and assistants wore the HoloLens when they performed TaTME.

Results

In a Wi-Fi-enabled operating room, each surgeon, wearing a HoloLens, shared the same hologram and succeeded in adjusting the hologram by making simple hand gestures from their respective angles. The hologram contributed to better comprehension of the positional relationships between the urethra and the surrounding pelvic organs during surgery. All surgeons were able to properly determine the dissection line.

Conclusions

This first experience suggests that intraoperative holograms contributed to reducing the risk of urethral injury and understanding transanal anatomy. Intraoperative holograms have the potential to become a new next-generation surgical support tool for use in spatial awareness and the sharing of information between surgeons.

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Availability of data and materials

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

Code availability

Not applicable.

Abbreviations

TaTME:

Transanal total mesorectal excision

HMD:

Head mount display

3D:

Three-dimensional

MR images:

Magnetic resonance images

MDCT:

Multi-detector computed tomography

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Acknowledgements

We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac), for editing draft of this manuscript. We also thank Holoeyes Inc. for their technical support.

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Authors and Affiliations

  1. Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Takuya Tokunaga, Yu Saito, Hideya Kashihara, Kozo Yoshikawa, Toshihiro Nakao, Masaaki Nishi, Chie Takasu, Yuma Wada, Toshiaki Yoshimoto, Shoko Yamashita, Yosuke Iwakawa, Noriko Yokota & Mitsuo Shimada

  2. Okinaga Research Institute, Teikyo University, Tokyo, Japan

    Maki Sugimoto

Authors
  1. Takuya Tokunaga
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  2. Maki Sugimoto
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  3. Yu Saito
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  4. Hideya Kashihara
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  5. Kozo Yoshikawa
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  7. Masaaki Nishi
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  8. Chie Takasu
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  9. Yuma Wada
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  14. Mitsuo Shimada
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Contributions

Takuya Tokunaga: study concepts and design, analysis and interpretation of data, manuscript preparation. Maki Sugimoto: drafting of the manuscript, software development, technical instruction, critical revision of the manuscript. Yu Saito: acquisition of data, analysis and interpretation of data. Hideya Kashihara: study concepts and design, technical instruction. Kozo Yoshikawa: statistical analysis. Toshihiro Nakao: study concepts and design, analysis and interpretation of data. Masaaki Nishi: statistical analysis. Chie Takasu: quality control of data and algorithms. Toshiaki Yoshimoto: acquisition of data. Shoko Yamashita: acquisition of data. Noriko Yokota: acquisition of data. Yosuke Iwakawa: acquisition of data. Mitsuo Shimada: drafting of the manuscript, critical revision of the manuscript.

Corresponding author

Correspondence to Takuya Tokunaga.

Ethics declarations

Ethics approval

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.

Consent to participate

All patients consented to participate.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Tokunaga, T., Sugimoto, M., Saito, Y. et al. Intraoperative holographic image-guided surgery in a transanal approach for rectal cancer. Langenbecks Arch Surg 407, 2579–2584 (2022). https://doi.org/10.1007/s00423-022-02607-4

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  • DOI: https://doi.org/10.1007/s00423-022-02607-4

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