Intraoperative augmented reality applied to laparoscopic right adrenalectomy

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Intraoperative augmented reality applied to laparoscopic right adrenalectomy

Authors

J Marescaux, D Mutter, L Soler

Keywords

intraoperative augmented reality,laparoscopic right adrenalectomy,adrenal glands,resection

Media type

Surgical video

Duration

08'00''

Publication

2004-12

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E-publication

WeBSurg.com, Dec 2004;4(12).
URL: http://www.websurg.com/doi-vd01en1561e.htm

Intraoperative augmented reality applied to laparoscopic right adrenalectomy

1. 3D virtual reconstruction 00'08''

This video will demonstrate intraoperative augmented reality applied to laparoscopic right adrenalectomy. We start with the CT image of the patient, which was obtained preoperatively. Here is the right adrenal tumor in question, which is measured to be 3.1cm in length and 2.4cm in width. 3D virtual reality reconstructions were made using a special software program and were superimposed onto the original CT image. The position of the tumor in relation to other anatomical structures can be appreciated. This can help with preoperative planning and simulation. The anatomy can be appreciated from different angles enhancing our appreciation of the 3D relationship between structures.

2. Trocar placement 01'04''

So the position is a total left lateral decubitus position. Now we will use a mix between the virtual reality image and preoperative simulation and the intraoperative image. Here we can see the costal margin and here the transparency is very well seen. Here we must make sure that we have the best position for placement of the 1st trocar (the optical trocar and the laparoscope). For the 2nd trocar, we don’t need to have any superimposition because it is only the retractor for the liver. So if we can have the simulation of this position, we can place the virtual grasper. Here is the virtual view in order to check that the virtual optic is exactly superimposed with the real optic. Here it’s perfect superimposition. The position is excellent and we can see exactly the operative field.

3. Dissection under virtual control 04'56''

Now we have controlled the major adrenal vein. Here we have a good plane that is the posterior muscle plane. Here is the middle artery. We have identified the major adrenal vein and we are now looking for the renal vein, which is likely to be here. Where my instrument is I would like to get the superimposition. Here it’s perfect. So here is the vein. Now to the rest of the operation. The major adrenal vessels have now been adequately controlled. The landmarks have been identified using augmented reality, and the surgeon is aware of the positions of the important anatomical structures. The operation can now be safely continued to completely free the right adrenal tumor. This is done rapidly using the Ligasure sealing device as shown here. The dissection is continued in the plane between the kidney and the adrenal. The sealing effect of the Ligasure ensures rapid dissection with secure hemostasis of any vessels. As evident, there is minimal bleeding of the tissues here. Counter-traction using the peanut always facilitates the dissection. The fact that the surgeon is aware of the important landmarks also allows for rapid and safe dissection. The dissection is continued posteriorly in order to completely free the adrenal gland and tumor. The gland and tumor are almost completely free. Once free, it is retrieved from the body, and this is the end of the operation.