Ramalhinho João, Bulathsinhala Sandun, Gurusamy Kurinchi, Davidson Brian R, Clarkson Matthew J
UCL Hawkes Institute, Department of Medical Physics and Biomedical Engineering, UCL, London, UK.
Division of Surgery and Interventional Science, UCL, London, UK.
Surg Endosc. 2025 Jul 25. doi: 10.1007/s00464-025-12008-5.
Augmented Reality (AR) is considered as a potential image guidance tool to increase the safety of laparoscopic liver surgery. By overlaying surface models of the liver and hepatic blood vessels derived from pre-operative 3D imaging onto the laparoscopic video images, surgeons can have more context on the surgical scene and perform more informed decisions. Although several techniques to enable AR have been reported, few studies have addressed clinical deployment feasibility and visual display requirements.
We present the results of a prospective study where a previously reported AR system, the Smartliver, has been evaluated with 13 participants consented for laparoscopic liver surgery. The system is optically tracked, the laparoscope is pre-operatively calibrated, and the AR overlay is obtained manually during surgery. We have prospectively tested 3 different AR displays and have obtained feedback from surgeons through Likert Scale questionnaires.
Questionnaire results on the suitability of displays for surgical use suggest the Smartliver AR overlay is intuitive, can help on decision-making, and has potential for future use. Surgeons showed preference for a display where only a restricted circular "hole" region of the 3D model is shown.
Optically tracked AR is easy to deploy, and surgeons agree on its potential to improve surgical outcomes of laparoscopic liver surgery. Future developments should focus on automating the AR overlay alignment process, predicting liver surface intra-operative deformations, and optimising the optical tracking system positioning.
增强现实（AR）被视为一种潜在的图像引导工具，可提高腹腔镜肝脏手术的安全性。通过将术前三维成像获得的肝脏和肝血管表面模型叠加到腹腔镜视频图像上，外科医生能够更好地了解手术场景，并做出更明智的决策。尽管已有多项实现AR的技术被报道，但很少有研究探讨其临床应用的可行性和视觉显示要求。
我们展示了一项前瞻性研究的结果，该研究对13名同意进行腹腔镜肝脏手术的参与者使用了此前报道的AR系统Smartliver进行评估。该系统采用光学跟踪，腹腔镜在术前进行校准，术中通过手动获取AR叠加图像。我们前瞻性地测试了3种不同的AR显示方式，并通过李克特量表问卷获得了外科医生的反馈。
关于显示器在手术中适用性的问卷调查结果表明，Smartliver的AR叠加图像直观，有助于决策制定，并且具有未来应用的潜力。外科医生更倾向于只显示三维模型中一个受限圆形“孔”区域的显示器。
光学跟踪的AR易于部署，外科医生认同其有改善腹腔镜肝脏手术结果的潜力。未来的发展应集中在自动化AR叠加图像的对齐过程、预测肝脏表面术中变形以及优化光学跟踪系统的定位。
