Assessing augmented reality displays in laparoscopic liver surgery - a clinical experience.

PURPOSE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.