A head-mounted display-based personal integrated-image monitoring system for transurethral resection of the prostate

Abstract

The head-mounted display (HMD) is a new image monitoring system. We developed the Personal Integrated-image Monitoring System (PIM System) using the HMD (HMZ-T2, Sony Corporation, Tokyo, Japan) in combination with video splitters and multiplexers as a surgical guide system for transurethral resection of the prostate (TURP). The imaging information obtained from the cystoscope, the transurethral ultrasonography (TRUS), the video camera attached to the HMD, and the patient's vital signs monitor were split and integrated by the PIM System and a composite image was displayed by the HMD using a four-split screen technique. Wearing the HMD, the lead surgeon and the assistant could simultaneously and continuously monitor the same information displayed by the HMD in an ergonomically efficient posture. Each participant could independently rearrange the images comprising the composite image depending on the engaging step. Two benign prostatic hyperplasia (BPH) patients underwent TURP performed by surgeons guided with this system. In both cases, the TURP procedure was successfully performed, and their postoperative clinical courses had no remarkable unfavorable events. During the procedure, none of the participants experienced any HMD-wear related adverse effects or reported any discomfort.

Keywords: cystoscopes; data display; prostatic hyperplasia; transurethral resection of prostate.

Figure 1

Overview of the personal integrated-image monitoring system. Multiple input information is split using an imaging splitter, and integrated into one composite image using a multiplexer. Each wearer of the head-mounted display (HMD) can independently arrange the array of the displayed images. In this figure, each type of input information is color coded: cystoscopy, green; transrectal ultrasonography, (TRUS), black; vital signs monitor, blue; HMD-mounted camera, red

Photo 1

Photograph of transurethral resection of the prostate being performed using the personal integrated-image monitoring system paired with transrectal ultrasonography. Both the lead surgeon and the assistant wear a head-mounted display during all stages of the procedure

Photo 2

Captured image of displayed integrated image data including the cystoscopic image, the transrectal ultrasonographic image, the patient's vital signs, and the view from a head-mounted camera attached on the head-mounted display. A – Composite image using the endoscopic image as the primary image. B – An arrangement using the ultrasonographic image as the primary image. On transrectal ultrasonography, the resectoscope (arrow heads) and the resection loop (white-outlined arrowheads) are clearly visible as a hyperechoic lines. However, the resectoscope hampered the visibility of the anterior part of the prostate

Photo 3

Captured images of the displayed data in the head-mounted display worn by the lead surgeon (A) and the assistant (B, C) during the resection of the posterior part of the prostate. On transrectal ultrasonography, the resectoscope (arrow heads) and the resection loop (white-outlined arrowheads) are clearly visible as a hyperechoic lines. The resected tissue is visible as a hyperechoic signal just after the electrical resection (arrow). After the resection was finished, the prostatic bed was clearly visible on transrectal ultrasonography (C)