The increasing distance between the surgeon and the surgical field is a significant problem in laparoscopic surgery. Robotic surgery, while providing clear advantages for the operator, increases this gap by completely removing force feedback. With the introduction of mixed reality in the robotic era, integrating novel visual enhancement tools with the da Vinci™(Intuitive Surgical Inc, Sunnyvale, CA, USA) stereoscopic vision may compensate for this loss. This study reports our preliminary experience using stereoscopic 3D volume rendered images coupled with the robotic system during biliary and colonic surgery.
Volume rendered images were obtained from standard computed tomography datasets using the OsiriX DICOM workstation. Regions of interest were highlighted and the relationship with patient’s vital anatomical structures established. A custom plugin allowed for stereoscopic volume rendered reconstruction within the da Vinci surgeon’s console, using TilePro™ multi-input display. The upper part of the screen showed the endoscopic operative view while the bottom showed the previously prepared reconstructed stereoscopic volumes. Images manipulated within OsiriX using a 3D mouse (3DConnexion Inc., Silicon Valley, CA, USA) installed on the console bar, are updated in real time in the Surgeon’s Console.
We performed robotic cholecystectomy for cholelithiasys. During the procedure, the surgeon switched several times to the split view, comparing the endoscopic and virtual images that appeared in his field of vision, looking for the spatial location of the gallbladder. Its relationship with the common hepatic duct and the common bile duct was easily established. Finally, the absence of aberrant biliary duct was confirmed. During total robotic right colectomy, tumor position, vascular supply, spatial location and relationships between organs appeared directly within the surgeon’s field of view. This allowed for a safer procedure; sight diversions out of the surgical field of view, looking for CT scan images, were no longer necessary. Depth perception was subjectively perceived as profitable. There were no intraoperative complications and postoperative course for all patients was uneventful.
Total immersion in the operative field may give the surgeon greater control over the surgical procedure, which partially replaces the lack of tactile feedback specific to robotic intervention. This innovative tool is another step towards augmented reality robot-assisted surgery.