Intraoperative augmented reality applied to laparoscopic left adrenalectomy

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Intraoperative augmented reality applied to laparoscopic left adrenalectomy

Authors

J Marescaux, D Mutter, L Soler

Classification

new techniques

Keywords

adrenal glands,laparoscopy,left adrenalectomy,augmented reality

Media type

Surgical video

Duration

05'00''

Publication

2004-11

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E-publication

WeBSurg.com, Nov 2004;4(11).
URL: http://www.websurg.com/doi-vd01en1613.htm

Intraoperative augmented reality applied to laparoscopic left adrenalectomy

1. CT-scan of the patient 00'08''

This video will demonstrate intraoperative augmented reality applied to laparoscopic left adrenalectomy. We start with a CT-scan of the patient and the reconstructed image of the tumor is superimposed in green.

2. 3D reconstruction 00'29''

Now the other organs are superimposed allowing us to preoperatively appreciate the internal anatomy. The virtual patient can be rotated in order to appreciate the anatomy from different angles.

3. Virtual trocar placement 00'44''

The magnification also facilitates preoperative planning. The local vascular anatomy is of importance and can be clearly seen here. Now to the external view. Here you can see the positions of the trocars are in superimposition for 3D reconstruction of the patient. Virtual instruments are also superimposed onto the real surgical tools. Now to the internal view. We begin the surgery with the dissection of the adhesions using monopolar scissors. The dissection is performed cautiously for some organs such as the colon can be damaged during the dissection. Here you can see the colon adhere to the abdominal wall.

4. Spleen mobilization 01'46''

Now the lienophrenic ligament must be divided using the dissection hook. The objective here is to perform a dissection in a plane posterior to the splenic vessels and the tail of the pancreas. One important point is the traction of the spleen to the left to open the plane and facilitate the dissection. The dissection is extended caudally and cephalad in order to obtain the correct exposure. Here we can see the splenic vein on the left side of the screen. The diathermy hook is used to open up this plane. The renal vein is likely to be in this area.

5. Renal vein 03'08''

Here is the renal vein. We now go on to open Gerota’s fascia to get access to the adrenal gland. The dissection is continued using the diathermy hook in order to isolate the branches from the renal vein taking care not to damage this large vessel. Dissection is continued taking care not to damage this large vessel. This virtual reality image shows the position of the instruments relative to the tissues. 3D reconstruction allows us to visualize anatomy from different angles to enhance the appreciation of the position of the adrenal vein. With this in mind, the dissection is continued to isolate the main adrenal vein. Back to the external view. Here we can see again the superimposition of the vena cava, the adrenal gland, the tumor, and the liver. Back to the internal view. The dissection of the adrenal vein is performed with the hook.

6. Main adrenal vein 05'00''

The accessory vein can be seen and also needs to be isolated. The superimposition is performed in order to clarify the vascular anatomy. We can clearly see here the positions of the vena cava, renal vein, and the main adrenal vein. Now to the dissection of the accessory adrenal vein. Once isolated, the main adrenal vein is clipped. It is then divided. The artery lies immediately behind it. It is also clipped, then divided. The dissection is now continued superiorly in order to achieve a complete resection of the adrenal gland. We can see the renal capsule coming into view here. The dissection is continued using the diathermy hook and controlling the multiple vessels, which supply the adrenal gland. Care is taken not to damage the renal capsule during this dissection. The dissection now remains to separate the adrenal gland from the kidney. This final vascular attachment is divided. Along with the detachment of the lateral aspect, the adrenal gland is completely free.

7. Specimen extraction 07'13''

It is placed carefully into an Endobag device and retrieved from the body. This is the end of the operation.