A three-dimensional head-mounted display system (RoboSurgeon system) for gasless laparoendoscopic single-port partial cystectomy

Abstract

We developed a new three-dimensional (3D) head-mounted display (HMD) system (RoboSurgeon system) that combines a high-definition 3D organic electroluminescent HMD with a high-definition 3D endoscope and applies it to minimally invasive surgery. This system presents the surgeon with a higher quality of magnified 3D imagery in front of the eyes, regardless of head position. We report 5 cases of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy, which is carried out as part of our selective bladder-sparing protocol, with a technique utilizing both an intravesical and extravesical approach. While carrying out the surgery, the system provides the surgeon with both excellent 3D imagery of the operative field and clear imagery of the cystoscopy. All procedures were safely completed and there were no complications except for a case of postoperative lymphorrhea. Our experience shows that the 3D HMD system might facilitate maneuverability and safety in various minimally invasive procedures.

Keywords: bladder cancer; cystoscope; head-mounted display; minimally invasive surgery; partial cystectomy; three-dimensional high-definition endoscope.

Figure 1

Outline of RoboSurgeon gasless single-port partial cystectomy

Photo 1

Photograph of RoboSurgeon gasless laparoendoscopic single-port partial cystectomy. All surgeons, including the TUR surgeon, wear a head-mounted display (A). After the intravesical approach is finished, the remaining procedures are carried out extravesically (B)

Photo 2

Intravesical approach. The Collins incision is deepened along the proposed resection margin through the serosa until full thickness is achieved. The TUR surgeon carries out this procedure while viewing the cystoscopic image as the main image and the laparoendoscopic image as the second image of the ‘Picture in Picture’ on the HMD (A), while the other surgeons view the laparoendoscopic image as the main image and the cystoscopic image as the second image to confirm that there is no inadvertent injury to surrounding structures or tissues (B). The TUR site can be easily recognized from outside of the bladder by the transmitted light of cystoscopy passing through the bladder wall

Figure 4

Photo 3. After the intravesical approach, the bladder wall is extravesically divided along the cystoscopically made margin line (arrow) by electric cautery while viewing the laparoendoscopic image (A). The bladder is closed in two layers (B)