Holographic image-guided thoracoscopic surgery: possibility of usefulness for esophageal cancer patients with abnormal a
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HOW I DO IT
Holographic image‑guided thoracoscopic surgery: possibility of usefulness for esophageal cancer patients with abnormal artery Yuta Sato1 · Maki Sugimoto2 · Yoshihiro Tanaka1 · Tomonari Suetsugu1 · Takeharu Imai1 · Yuji Hatanaka1 · Nobuhisa Matsuhashi1 · Takao Takahashi1 · Kazuya Yamaguchi1 · Kazuhiro Yoshida1 Received: 8 January 2020 / Accepted: 28 March 2020 © The Japan Esophageal Society 2020
Abstract Background With the recent improvement of medical image analysis technology, three-dimensional (3D) holograms technology is beginning to be used as intraoperative image support. Case presentation We used a wearable holographic computer during thoracoscopic esophagectomy in a 70-year-old man with esophageal cancer. During lymph node dissection around the right recurrent laryngeal nerve, abnormal blood vessels were observed beside the right subclavian artery (RSA). As a result of confirming the anatomical variation of the right vertebral artery (RVA) using the 3D holograms, it was possible to understand that the RVA branched from a low position on the RSA. Conclusions Holographic image-guided thoracoscopic esophagectomy using wearable holographic computer provided better spatial recognition of vascular variation and safe lymph node dissection. Keywords Thoracoscopic esophagectomy · Esophageal cancer · 3D holograms
Introduction
Methods
The improvements made in the performance of medical image analysis and visualization devices in recent years have been remarkable, and three-dimensional (3D) holograms are being used in clinical settings [1]. 3D holograms that are created before surgery are projected onto a clean surgical field during surgery to create a stereoscopic view, thus, enabling better spatial recognition and sharing of images between surgeons involved in the surgery [2, 3]. We used 3D holograms as imaging support during thoracoscopic esophagectomy to recognize the anatomical variation of the right vertebral artery (RVA) more spatially. This is the first report of the successful esophagectomy using 3D holograms.
3D holograms were made using data from a contrastenhanced computed tomography (CT) taken in prone position and “SYNAPSE VINCENT” software (Fuji Film Medical Co Ltd, Tokyo, Japan). SYNAPSE VINCENT is the 3D image analysis system and visualizes medical images in 3D to be used for image diagnosis and surgical simulation. Polygon (Standard Triangulated Language format: STL format) files were exported from SYNAPSE VINCENT, and these were upload into the “HoloeyesXR” system (Holoeyes Inc, Tokyo, Japan). HoloeyesXR is the 3D extended reality cloud service and converts 3D organ polygons into holographic application. After uploading the data, 3D images were automatically converted as case-specific data sets into realistic 3D holographic experience on a wearable computer [4]. 3D holograms can freely represent or erase blood vessels and other organs such as trachea, esophagus and vertebral body onto the clean surgical field, and can change the orientation and axis according to the body positio
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