Saito Yu, Morine Yuji, Yamada Shinichiro, Teraoku Hiroki, Miyazaki Katsuki, Ikemoto Tetsuya, Shimada Mitsuo
Department of Surgery, Tokushima University, Tokushima, Japan.
Ann Surg Oncol. 2025 Sep 8. doi: 10.1245/s10434-025-18297-3.
Although magnification is an advantage of robotic liver resection (RLR) as it enables precise surgery, the direction of parenchymal dissection, the vascular anatomy, and the tumor location can sometimes be lost. Extended reality (XR) has advantages over other navigation systems in terms of spatial awareness, sharing, and simplicity, and it also has the potential to overcome some of the limitations of RLR. METHODS: In this video, we demonstrate innovative RLR with XR by three separate surgeons. A 63-year-old male patient with two colorectal liver metastases in both segment 5 and 6 respectively, and subsegmentectomy was performed. A console surgeon executes parenchymal dissection with the clamp-crush method. An assistant surgeon uses CUSA to support parenchymal dissection, especially when securing the Glissonean pedicle. A nonsterilized XR surgeon projects the patient's own "hologram" onto the monitor, which is tilted in the same direction as the surgical field to check (1) the approximate tumor location, (2) the correctness of the dissection direction, and (3) the Glisson or hepatic veins that will appear.
The three surgeons continuously share operative information, which also serves as an educational resource for residents and medical students. A total blood loss was 20 ml, and operation time was 178 min. The patient was discharged on postoperative day 8.
This is the world's first report of RLR with XR, which is an innovative approach that can contribute not only to real-time navigation, but also to medical education.
尽管放大功能是机器人肝切除术（RLR）的一个优势，因为它能实现精确手术，但有时会失去实质解剖方向、血管解剖结构以及肿瘤位置。扩展现实（XR）在空间感知、共享和简便性方面优于其他导航系统，并且它也有潜力克服RLR的一些局限性。方法：在本视频中，我们展示了三位不同的外科医生使用XR进行的创新性RLR。一名63岁男性患者，在肝段5和6分别有两个结直肠癌肝转移灶，进行了亚肝段切除术。主刀医生使用钳夹挤压法进行实质解剖。助手医生使用超声外科吸引器（CUSA）辅助实质解剖，特别是在处理肝蒂时。一名未消毒的XR医生将患者自身的“全息图”投射到显示器上，显示器与手术视野倾斜相同方向，以检查（1）肿瘤大致位置，（2）解剖方向的正确性，以及（3）即将出现的肝门或肝静脉。
三位外科医生持续共享手术信息，这也为住院医师和医学生提供了教育资源。总失血量为20毫升，手术时间为178分钟。患者术后第8天出院。
这是世界上首次关于使用XR进行RLR的报告，这是一种创新方法，不仅有助于实时导航，还对医学教育有贡献。
