Evaluating the Potential Benefit of Autostereoscopy in Laparoscopic Sacrocolpopexy through VR Simulation

Abstract

During laparoscopic sacrocolpopexy, pelvic organ prolapse is repaired by suturing one side of a synthetic mesh around the vaginal vault while stapling the other end to the sacrum, restoring the anatomical position of the vagina. A perineal assistant positions and tensions the vault with a vaginal manipulator instrument to properly expose the vaginal tissue to the laparoscopic surgeon. A technical difficulty during this surgery is the loss of depth perception due to visualization of the patient's internals on a 2D screen. Especially during precise surgical tasks, a more natural way to understand the distance between the laparoscopic instruments and the surgical region of interest could be advantageous. This work describes an exploratory study to investigate the potential of introducing 3D visualization into this surgical intervention. More in particular, experimentation is conducted with autostereoscopic display technology. A mixed reality setup was constructed featuring a virtual reality model of the vagina, 2D and 3D visualization, a physical interface representing the tissue of the body wall and a tracking system to track instrument motion. An experiment was conducted whereby the participants had to navigate the instrument to a number of pre-defined locations under 2D or 3D visualization. Compared to 2D, a considerable reduction in average task time (-42.9 %), travelled path lenght (-31.8 %) and errors (-52.2 %) was observed when performing the experiment in 3D. Where this work demonstrated a potential benefit of autostereoscopic visualization with respect to 2D visualization, in future work we wish to investigate if there also exists a benefit when comparing this technology with conventional stereoscopic visualization and whether stereoscopy can be used for (semi-) automated guidance during robotic laparoscopy.