Intraoperative holography navigation using a mixed-reality wearable computer during laparoscopic cholecystectomy.

Abstract

Mixed-reality technology, a new digital holographic image technology, is used to present 3-dimensional (3D) images in the surgical space using a wearable mixed-reality device. This study aimed to assess the safety and efficacy of laparoscopic cholecystectomy using a holography-guided navigation system as an intraoperative support image.In this prospective observational study, 27 patients with cholelithiasis or mild cholecystitis underwent laparoscopic cholecystectomy between April 2020 and November 2020. Nine patients underwent laparoscopic cholecystectomy with 3D models generated by a wearable mixed-reality device (laparoscopic cholecystectomy with 3D models) and 18 underwent laparoscopic cholecystectomy with conventional two-dimensional images (laparoscopic cholecystectomy with 2D images) as surgical support images. Surgical outcomes such as operative time, blood loss, and perioperative complication rate were measured, and a four-item questionnaire was used for subjective assessment. All surgeries were performed by a mid-career and an experienced surgeon. Median operative times of laparoscopic cholecystectomy with 3-dimensional models and 2-dimensional images were 74.0 and 58.0 minutes, respectively. No intraoperative blood loss or perioperative complications occurred. Although the midcareer surgeon indicated that laparoscopic cholecystectomy with 3-dimensional models was "normal" or "easy" compared with 2-dimensional images in all cases, the experienced surgeon rated 3-dimensional models as more difficult in 3 (33%) of 9 cases. This study provides evidence that laparoscopic cholecystectomy with 3-dimensional models is feasible. However, the efficacy of laparoscopic cholecystectomy with 3-dimensional models may depend on the surgeon's experience, as indicated by the different ratings provided by the surgeons.