Page 141 - Demo

AugmentedrealityforDIEPflapharvest1398INTRODUCTIONIndeepinferiorepigastricperforator(DIEP)flapsurgeryitisessentialtoidentifythelocationsizeandrelationsoftheepigastricarteriesanditsperforatorsinthepatientAcquiringacomputedtomographyangiogramoramagneticresonanceangiogram of apatient’s abdomen can enhance thepreoperativeunderstanding ofthesurgicalsiteandreducessurgerytimeandpossiblycomplications1–3Becausethesurgeoncannotseetheseimagessimultaneouslywiththeoperatingfieldtheimageshave tobememorizedduringsurgery whichlimits the fullpotentialof theimagingAlternativelyDopplerultrasoundcanbeusedtoidentifythelocationoftherelevantvesselsHowever,thisapproachcanbelengthyandinaccurateanddoesnotshow theintra-muscular arterialcourse and therelationshipbetween theperforators4–6Aninnovativetwo-dimensionalprojectortovisualizetheanatomyonthepatientwasrecentlydeveloped7–9butitdoesnotallowthevisualizationoftheanatomyinthreedimensions(3D)andthedeviceneedstobeoperatedwithatleastonehandWepresentanovelworkflowtovisualizetherelevant3DabdominalanatomyforaDIEP flapharvest with theMicrosoftHoloLens(MicrosoftCorpRedmond Wash)augmentedrealityglasses10–12 whichprovideahands-free3D visualizationandareintuitivetousePATIENTSANDMETHODSWORKFLOWTheworkflowtoachieveaholographicaugmentedrealityvisualizationconsistsoffoursteps(1)imageacquisitionandsegmentationoftherelevantanatomicalstructures (2) importing the relevant anatomy to an in-house–developedHoloLensapplication(3)real-timetrackingofthepatient(4)registrationandvisualizationoftheholographicanatomyinthepatientAvideowhichdemonstratestheimplementationofourHoloLensworkflowtomarktheperforatorsontheabdomenofthe patientcanbefoundonlineonwww.PRSJournal.com