Navigated laparoscopic microwave ablation of tumour mimics in pig livers: a randomized ex-vivo experimental trial

Clinical use of augmented reality, mixed reality, three-dimensional-navigation and artificial intelligence in liver surgery

A precise knowledge of intra-parenchymal vascular and biliary architecture and the location of lesions in relation to the complex anatomy is indispensable to perform liver surgery. Therefore, virtual three-dimensional (3D)-reconstruction models from computed tomography/magnetic resonance imaging scans of the liver might be helpful for visualization. Augmented reality, mixed reality and 3D-navigation could transfer such 3D-image data directly into the operation theater to support the surgeon. This review examines the literature about the clinical and intraoperative use of these image guidance techniques in liver surgery and provides the reader with the opportunity to learn about these techniques. Augmented reality and mixed reality have been shown to be feasible for the use in open and minimally invasive liver surgery. 3D-navigation facilitated targeting of intraparenchymal lesions. The existing data is limited to small cohorts and description about technical details e.g., accordance between the virtual 3D-model and the real liver anatomy. Randomized controlled trials regarding clinical data or oncological outcome are not available. Up to now there is no intraoperative application of artificial intelligence in liver surgery. The usability of all these sophisticated image guidance tools has still not reached the grade of immersion which would be necessary for a widespread use in the daily surgical routine. Although there are many challenges, augmented reality, mixed reality, 3D-navigation and artificial intelligence are emerging fields in hepato-biliary surgery.

[New techniques and training methods for robot-assisted surgery and cost-benefit analysis of Ivor Lewis esophagectomy]

INTRODUCTION

Robotic surgery was introduced into general surgery more than 20 years ago. Shortly afterwards, Horgan performed the first robotic-assisted esophagectomy in 2003 in Chicago. The aim of this manuscript is to elucidate new developments and training methods in robotic surgery with a cost-benefit analysis for robotic-assisted Ivor Lewis esophagectomy.

METHODS

Systematic literature search regarding new technology and training methods for robotic surgery and cost analysis of intraoperative materials for hybrid and robotic-assisted Ivor Lewis esophagectomy.

RESULTS

Robotic-assisted esophageal surgery is complex and involves an extensive learning curve, which can be shortened with modern teaching methods. New robotic systems aim at the use of image-guided surgery and artificial intelligence. Robotic-assisted surgery of esophageal cancer is significantly more expensive that surgery without this technology.

CONCLUSION

Oncological short-term and long-term benefits need to be further evaluated to support the higher cost of robotic esophageal cancer surgery.