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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

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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:

© 2019 The American Society of Colon and Rectal Surgeons