Integrated image monitoring system using head-mounted display for gasless single-port clampless partial nephrectomy

Abstract

A novel head-mounted display (HMD) offers a higher quality of endoscopic imagery in front of the eyes regardless of head position. We present an application of the HMD system as a personal integrated multi-image monitoring system in gasless single-port clampless partial nephrectomy (PN). Our HMD system displayed multiple forms of information as integrated, sharp, high-contrast images both seamlessly and synchronously using a four-split screen. The surgeon wearing an HMD display could continuously and simultaneously monitor the endoscopic, three-dimensional (3D) video and intraoperative ultrasound images. In addition, the operator can rotate the 3D video image using fingertip movements on the finger tracking system. All two clampless partial nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The integrated image HMD system might facilitate maneuverability and safety in minimally invasive clampless PN.

Keywords: clampless; partial nephrectomy; three-dimensional image.

Photo 1

A scene of gasless single-port clampless partial nephrectomy performed using the head-mounted display system (HMD). A – The operator resects the kidney parenchyma using an ultrasonic coagulating device while looking at the integrated multiple image in the HMD. The HMD provides the endoscopic image (B), 3D image (C), 3D video image (D) and ultrasound image (E) simultaneously as integrated image information in front of the eyes in the HMD monitor. The 3D video image is rotated to adjust the direction to the endoscopic view to confirm the location of the tumor (arrow head) and related structures

Photo 2

Rotation of the 3D video image according to the operator's fingertip movement. A – Video camera (black arrow head) was mounted to track the operator's index finger (arrow head). The operator moved their fingertip (arrow head, yellow arrow) (from B to B’) to adjust the direction of the 3D video image to the onsite endoscopic view looking at the integrated multiple image in the head-mounted display (from C to C’)