Document Detail

Mixed reality for robotic treatment of a splenic artery aneurysm.
MedLine Citation:
PMID:  19826869     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Techniques of mixed reality can successfully be used in preoperative planning of laparoscopic and robotic procedures and to guide surgical dissection and enhance its accuracy.
METHODS: A computer-generated three-dimensional (3D) model of the vascular anatomy of the spleen was obtained from the computed tomography (CT) dataset of a patient with a 3-cm splenic artery aneurysm. Using an environmental infrared localizer and a stereoscopic helmet, the surgeon can see the patient's anatomy in transparency (augmented or mixed reality). This arrangement simplifies correct positioning of trocars and locates surgical dissection directly on top of the aneurysm. In this way the surgeon limits unnecessary dissection, leaving intact the blood supply from the short gastric vessels and other collaterals. Based on preoperative planning, we were able to anticipate that the vascular exclusion of the aneurysm would result in partial splenic ischemia. To re-establish the flow to the spleen, end-to-end robotic anastomosis of the splenic artery with the Da Vinci surgical system was then performed. Finally, the aneurysm was fenestrated to exclude arterial refilling.
RESULTS: The postoperative course was uneventful. A control CT scan 4 weeks after surgery showed a well-perfused and homogeneous splenic parenchyma. The final 3D model showed the fenestrated calcified aneurysm and patency of the re-anastomosed splenic artery.
CONCLUSIONS: The described technique of robotic vascular exclusion of a splenic artery aneurysm, followed by re-anastomosis of the vessel, clearly demonstrates how this technology can reduce the invasiveness of the procedure, obviating an otherwise necessary splenectomy. Also, the use of intraoperative mixed-reality technology proved very useful in this case and is expected to play an increasing role in the operating room of the future.
Andrea Pietrabissa; Luca Morelli; Mauro Ferrari; Andrea Peri; Vincenzo Ferrari; Andrea Moglia; Luigi Pugliese; Fabio Guarracino; Franco Mosca
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Publication Detail:
Type:  Video-Audio Media     Date:  2009-10-14
Journal Detail:
Title:  Surgical endoscopy     Volume:  24     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-28     Completed Date:  2010-08-17     Revised Date:  2010-12-02    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1204     Citation Subset:  IM    
Sezione di Chirurgia Mininvasiva, Divisione di Chirurgia I Universitaria, Dipartimento di Oncologia, dei Trapianti e Delle Nuove Tecnologie in Medicina, Università di Pisa, Ospedale di Cisanello, via Paradisa 2, 56124 Pisa, Italy.
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MeSH Terms
Anastomosis, Surgical / methods
Aneurysm / surgery*
Follow-Up Studies
Imaging, Three-Dimensional / methods*
Robotics / methods*
Splenic Artery*
User-Computer Interface*
Vascular Surgical Procedures / methods*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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