Application of Extended Reality (Virtual Reality and Mixed Reality) Technology in Laparoscopic Liver Resections

Advancing precision, safety, and education in D3 lymph node dissection for right hemicolectomy using mixed reality technology

Right hemicolectomy (RHC) is an important treatment for colorectal cancer. The superior mesenteric artery and superior mesenteric vein are known for their significant vascular variations. This study evaluated the short-term outcomes of integrating Mixed Reality (MR) technology into RHC for the treatment of colorectal cancer. Patients who underwent RHC for clinical stage II or III colon cancer between January 2015 and August 2024 were included. Patients were divided into two groups: the MR (+) group (n = 47), in which MR was used, and the MR (-) group (n = 145), in which MR was not used. MR using SYNAPSE VINCENT, Holoeyes MD, and HoloLens2 was utilized for detailed 3D visualization of the vascular anatomy preoperatively and intraoperatively. Forty-four patients per group were matched via propensity score matching and surgical outcomes were compared. In both groups, approximately 70% of the surgeries were performed by the training surgeon. Compared with the MR (-) group, intraoperative blood loss and hospital stay were decreased, and the number of lymph nodes harvested around the middle colic artery/vein were increased without prolonging the operative time in the MR (+) group. MR in RHC offers surgical precision, safety, enhanced patient recovery, and educational value.

Construction of a Multimodal 3D Atlas for a Micrometer-Scale Brain-Computer Interface Based on Mixed Reality

OBJECTIVE

To develop a multimodal imaging atlas of a rat brain-computer interface (BCI) that incorporates brain, arterial, bone tissue and a BCI device using mixed reality (MR) for three-dimensional (3D) visualization.

METHODS

An invasive BCI was implanted in the left visual cortex of 4-week-old Sprague-Dawley rats. Multimodal imaging techniques, including micro-CT and 9.0 T MRI, were used to acquire images of the rat cranial bone structure, vascular distribution, brain tissue functional zones, and BCI device before and after implantation. Using 3D-slicer software, the images were fused through spatial transformations, followed by image segmentation and 3D model reconstruction. The HoloLens platform was employed for MR visualization.

RESULTS

This study constructed a multimodal imaging atlas for rats that included the skull, brain tissue, arterial tissue, and BCI device coupled with MR technology to create an interactive 3D anatomical model.

CONCLUSIONS

This multimodal 3D atlas provides an objective and stable reference for exploring complex relationships between brain tissue structure and function, enhancing the understanding of the operational principles of BCIs. This is the first multimodal 3D imaging atlas related to a BCI created using Sprague-Dawley rats.

The Effect of Hepatic Surgical Margins of Colorectal Liver Metastases on Prognosis: A Systematic Review and Meta-Analysis

Introduction: Colorectal cancer is the third most common malignancy, with around half of patients developing liver metastases. Hepatectomy is the preferred treatment, but its success depends on several factors, including surgical margins. Various surgical margins have been suggested to achieve optimal results. This systematic review and meta-analysis aim to explore the impact of negative surgical margins ranging from 1 to 10 mm, and >10 mm on survival, with the objective of identifying optimal surgical margins. Methods: A systematic literature search was conducted on the MEDLINE, Scopus, and Cochrane databases. The six included studies that examined the effect of surgical margins at the aforementioned distances on patient survival. Studies were assessed for risk of bias using the Quality in Prognosis Studies tool. Statistical analysis was performed using SPSS software. Results: The results of the meta-analysis revealed the superiority of wider surgical margins (>10) on overall survival compared to smaller margins (1-10 mm), as the HR was calculated to be 1.38 [1.10; 1.73]. Specifically, negative margins between 1 and 10 mm are linked to a 38% increased risk of mortality compared to margins larger than 10 mm. The low heterogeneity indicates consistent findings across studies, and the statistically significant hazard ratio underscores the importance of aiming for larger surgical margins to enhance patient outcomes. In the subgroup that included only studies in which patients received neoadjuvant therapy, the HR was 1.48 [1.06; 2.07], further emphasizing the importance of ensuring negative surgical margins in today's era. Conclusions: In summary, this systematic review and meta-analysis highlights the impact of surgical margin width on the survival of patients with colorectal liver metastases, as well as the importance of margin optimization in surgical management strategies.

Laparoscopic and robotic hepatectomy in living liver donors. Current state and prospects

Minimally invasive living-donor hepatectomy is a relatively new surgical technique that can improve donor safety and expedite donor rehabilitation. Following an early stage of research where donor safety was not adequately established, the minimally invasive approach nowadays yields better outcomes when carried out by experienced surgeons. Important factors include donor selection criteria, hospital equipment, and surgeon’s learning curve. This review describes the current status of laparoscopic and robotic living-donor hepatectomy, along with the challenges facing the advancement of these surgical techniques.

Apple Vision Pro and Its Implications in Mohs Micrographic Surgery: A Narrative Review

Mohs micrographic surgery (MMS) is a precise and effective technique for treating skin cancers, necessitating high accuracy and real-time decision-making to ensure complete tumor removal while preserving healthy tissue. The introduction of the Apple Vision Pro (AVP), an advanced mixed-reality headset, presents a potential technological advancement in surgical practice. The present investigation explores the integration of AVP into Mohs surgery, focusing on its potential to enhance preoperative planning, intraoperative guidance, and postoperative analysis. The AVP's high-resolution displays, advanced eye-tracking technology, and real-time data overlay capabilities may assist in meticulous surgical planning and execution. In the preoperative phase, AVP enables the creation and manipulation of detailed 3D models, providing comprehensive visualizations of tumor margins and critical structures. During surgery, AVP's real-time data overlay aids in precise tumor excision and spatial orientation, reducing errors and improving outcomes. Postoperatively, the AVP facilitates detailed procedural reviews and serves as a robust educational tool for surgical trainees. Despite its promising applications, challenges such as real-time resolution limitations, potential eye strain from prolonged use, and high costs must be addressed for widespread clinical adoption. This review highlights the transformative potential of AVP in Mohs surgery and underscores the need for further research to optimize integration and maximize benefits in dermatological procedures.