Evaluation of an augmented reality based image guidance system for laparoscopic liver surgery

Abstract

Background: Use of augmented reality (AR) based image guidance systems (IGS) has been proposed as a method to improve anatomical orientation during laparoscopic liver surgery (LLS) with potential benefits for patients. In this study, an AR based IGS (SmartLiver) was evaluated intraoperatively for the first time. In addition enhanced visualisation methods with the potential to improve mental integration between surgeons and AR environment will be presented. Methods: Patients scheduled for staging laparoscopy or LLS were recruited. During surgery a 3D liver model was manually overlayed onto the laparoscopic screen (registration) to create an AR environment. Surgeons scored IGS performance and accuracy on a scale (1-10). Objective accuracy was calculated by measuring distances of anatomical landmarks between 3D model and in-situ liver (mm RMS). Results: Ten patients were recruited to the study. Ease of use, mental integration and accuracy were rated positively (8 each). Length of setup time was rated negatively (2). Objectively measured accuracy was 137±39. A consensus was reached to integrate depth fogging, outlining and plane clipping as enhanced visualisation features into SmartLiver (video). Conclusion: The findings of this study demonstrate that SmartLiver is easy to use and capable of creating an AR environment that integrates well into the surgical workflow. Enhanced visualisation methods may improve the interpretation of AR data. An automatic registration method is needed to improve accuracy and setup time.