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Head-Mounted Mixed-Reality Technology During Robotic-Assisted Transanal Total Mesorectal Excision

Huber, Tobias, M.D.1; Hadzijusufovic, Edin, M.D.1; Hansen, Christian, Ph.D., M.Sc.2; Paschold, Markus, M.D.1; Lang, Hauke, M.A., M.D.1; Kneist, Werner, M.D.1

doi: 10.1097/DCR.0000000000001282
Technical Notes
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INTRODUCTION: Head-mounted mixed-reality technologies may enable advanced intraoperative visualization during visceral surgery. In this technical note, we describe an innovative use of real-time mixed reality during robotic-assisted transanal total mesorectal excision.

TECHNIQUE: Video signals from the robotic console and video endoscopic transanal approach were displayed on a virtual monitor using a head-up display. The surgeon, assistant, and a surgical trainee used this technique during abdominal and transanal robotic-assisted total mesorectal excision. We evaluated the feasibility and usability of this approach with the use of validated scales.

RESULTS: The technical feasibility of the real-time visualization provided by the current setup was demonstrated for both the robotic and transanal parts of the surgery. The surgeon, assistant, and trainee each used the mixed-reality device for 15, 55, and 35 minutes. All participants handled the device intuitively and reported a high level of comfort during the surgery. The task load was easily manageable (task load index: <4/21), although the surgeon and assistant both noted a short delay in the real-time video.

CONCLUSION: The implementation of head-mounted mixed-reality technology during robotic-assisted transanal total mesorectal excision can benefit the operating surgeon, assistant, and surgical trainee. Further improvements in display quality, connectivity, and systems integration are necessary.

1 Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Germany

2 Institute of Simulation and Graphics, Faculty of Computer Science, Otto-von-Guericke University Magdeburg, Germany

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Funding/Support: Funding for the technical equipment was provided by intramural funding from the University Medical Centre of the Johannes Gutenberg University of Mainz.

Financial Disclosures: None reported.

Correspondence: Werner Kneist, M.D., Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany, E-mail: werner.kneist@unimedizin-mainz.de

© 2019 The American Society of Colon and Rectal Surgeons