Application of holographic image navigation in urological laparoscopic and robotic surgery

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery. Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan. 2019 to Dec. 2019 in Beijing United Family Hospital and other 18 medical centers, including 78 cases of renal tumor, 2 cases of bladder cancer, 2 cases of adrenal gland tumor, 1 cases of renal cyst, 1 case of prostate cancer, 1 case of sweat gland carcinoma with lymph node metastasis, 1 case of pelvic metastasis after radical cystectomy. All the patients underwent operations. In the laparoscopic surgery group, there were 27 cases of partial nephrectomy, 1 case of radical prostatectomy, 2 cases of radical cystectomy and 2 cases of adrenalectomy. In the da Vinci robotic surgery group of 54 cases, there were 51 cases of partial nephrectomy, 1 case of retroperitoneal lymph node dissection, 1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis. There were 41 partial nephrectomy patients with available clinical data for statistic, with a median age of 53.5 years (range 24-76), including 26 males and 15 females. The median R. E.N.A.L score was 7.8 (range 4-11). Before the operation, the engineers established the holographic image based on the contrast CT images and reports. The surgeon applied the holographic image for preoperative planning. During the operation, the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen. Results All the procedures had been complete uneventfully. The holographic images helped surgeon in understanding the visual three- dimension structure and relation of vessels supplying tumor or resection tissue, lymph nodes and nerves. By manipulating the holographic images extracorporeally, the fused image guide surgeons about location vessel, lymph node and other important structure and then facilitate the delicate dissection. For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy, the median operation time was 140(range 50-225)min, the median warm ischemia time was 23(range 14-60)min, the median blood loss was 80(range 5-1 200)ml. In the robotic surgery group, the median operation time was 140(range 50-215)min, the median warm ischemia time was 21(range 17-40)min, the median blood loss was 150(range 30-1 200)ml. In the laparoscopic surgery group, the median operation time was 160(range 80-225)min, the median warm ischemia time was 25(range 14-60)min, the median blood loss was 50(range 5-1 200)ml. All the patients had no adjacent organ injury during operation. There were 2 cases with Clavien Ⅱcomplications. One required transfusion and the other one suffered hematoma post-operation. However, the tumors were located in the renal hilus for these 2 cases and the R. E.N.A.L scores were both 11. Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures.. This technique will reduce the tissue injury, decrease the complications and improve the success rate of surgery. Key words: Laparoscopic; 3 dimension image reconstruction; Holographic Imaging; Laparoscopic surgery; Robotic surgery