Holography Supported Minimally Invasive Cardiac Surgery: A Proof Of Concept And First-in-man
Ilias Skaltsiotis, Gao Yujia, Winn Maung, Guohao Chang, Jai Sule, Laszlo Kiraly, Theodoros Kofidis.
National University Hospital Singapore, Singapore, Singapore.
BACKGROUND:Successful minimally invasive cardiac surgery (MICS), and especially via the totally endoscopic approach, relies on correctly placing incisions and ports in order to attain sufficient exposure and efficiency, and minimize trauma. We enhanced surgical decision making using holographic guidance based on preoperative three-dimensional computed tomography reconstruction.
METHODS: We conducted a First-in-Man application of Holography in Cardiac Surgery: In three MICS cases, using the raw data from three-dimensional computed tomography and specialized slicer software, we created holograms of the heart, ribcage and the great vessels. In the case of MICS aortic valve replacement, we focused on the position of the valve and the aorta. In MICS multivessel coronary artery bypass surgery, we focused on the aorta and the course of the left internal mammary artery and coronaries. Lastly, in the MICS pulmonary valve replacement case, focus was on the valve annulus.After the patient was scrubbed and prepped, the acquired holographic image was superimposed to the exposed patient’s chest 1-to-1 using anatomical landmarks, such as the clavicle and the xiphoid, using a virtual reality headset and software. Decisions were made using the holographic landmark regarding optimal site of incision, anticipated topography of the instruments and anticipated difficulty of the case.RESULTS: Determining the optimal incision site preoperatively and recognizing its precise location facilitated optimal exposure in all cases. Finer slices of computed tomography result in higher fidelity of the hologram. A gated computed tomography coronary angiogram is ideal for constructing holograms of the mammary arteries and the coronaries, whereas for imaging intrathoracic topography, congenital anomalies and assessing the anticipated degree of difficulty and available space a contrasted high resolution computed tomography is sufficient.
CONCLUSIONS: While still in a stage of Proof-of-Concept, super-imposed holographic rendering with a specialized toolkit facilitate certain useful surgical decisions in minimally invasive cardiac surgery, and may help enhance efficacy and ergonomics of the surgical procedure.
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