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Transanal lateral lymph node dissection with intraoperative hologram support in low rectal cancer

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Abstract

Background

In Japan, the standard treatment for stage II/III advanced low rectal cancer is total mesorectal excision plus lateral lymph node dissection (LLND). There are also recent reports on the use of transanal LLND. However, the transanal anatomy is difficult to understand, and additional support tools are required to improve the surgical safety. The present study examined the utility of holograms with mixed reality as an intraoperative support tool for assessing the complex pelvic anatomy.

Methods

Polygon (stereolithography) files of patients’ pelvic organs were created and exported from the SYNAPSE VINCENT imaging system and uploaded into the Holoeyes MD virtual reality software. Three-dimensional images were automatically converted into patient-specific holograms. Each hologram was then installed into a head mount display (HoloLens2), and the surgeons and assistants wore the HoloLens2 when they performed transanal LLND. Twelve digestive surgeons with prior practice in hologram manipulation evaluated the utility of the intraoperative hologram support by means of a questionnaire.

Results

Intraoperative hologram support improved the surgical understanding of the lateral lymph node region anatomy. In the questionnaire, 75% of the surgeons answered that the hologram accurately reflected the anatomy, and 92% of the surgeons answered that the anatomy was better understood by simulating the hologram intraoperatively than preoperatively. Moreover, 92% of the surgeons agreed that intraoperative holograms were a useful support tool for improving the surgical safety.

Conclusions

Intraoperative hologram support improved the surgical understanding of the pelvic anatomy for transanal LLND. Intraoperative holograms may represent a next-generation surgical tool for transanal LLND.

Graphical abstract

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Abbreviations

CT:

Computed tomography

HMD:

Head mount display

LLN:

Lateral lymph node

LLND:

Lateral lymph node dissection

MRI:

Magnetic resonance imaging

MDCT:

Multidetector computed tomography

OLN:

Obturator lymph node

TME:

Total mesorectal excision

3D:

Three-dimensional

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Acknowledgements

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

Funding

All authors declare that they received no sources of funding for the research.

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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, Yuhei Waki, Toshiaki Yoshimoto, Takayuki Noma & Mitsuo Shimada

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

    Maki Sugimoto

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  1. Takuya Tokunaga
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Corresponding author

Correspondence to Takuya Tokunaga.

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Disclosures

Dr Maki Sugimoto is an employee of Holoeyes Inc. Drs Takuya Tokunaga, Maki Sugimoto, Yu Saito, Hideya Kashihara, Kozo Yoshikawa, Toshihiro Nakao, Masaaki Nishi, Chie Takasu, Yuma Wada, Yuhei Waki, Toshiaki Yoshimoto, Takayuki Noma, and Mitsuo Shimada have no conflicts of interest or financial ties to disclose.

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Tokunaga, T., Sugimoto, M., Saito, Y. et al. Transanal lateral lymph node dissection with intraoperative hologram support in low rectal cancer. Surg Endosc 37, 5414–5420 (2023). https://doi.org/10.1007/s00464-023-09977-w

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  • DOI: https://doi.org/10.1007/s00464-023-09977-w

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