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Case Reports
. 2024 Jun 3;7(4):320-323.
doi: 10.1002/iju5.12735. eCollection 2024 Jul.

Successful laparoscopic retroperitoneal tumor resection using mixed reality and guiding marker techniques

Yoichiro Tohi  1 , Homare Okazoe  1 , Katsuya Mitamura  2 , Yu Osaki  1 , Kenichi Tanaka  2 , Yuki Matsuoka  1 , Yoshihiro Nishiyama  2 , Kenji Kanenishi  3 , Mikio Sugimoto  1
Affiliations
Case Reports

Successful laparoscopic retroperitoneal tumor resection using mixed reality and guiding marker techniques

Yoichiro Tohi et al. IJU Case Rep. .

Abstract

Introduction: Small tumors may be difficult to identify visually and require preoperative effort to locate. Recent advancements in mixed reality technology have improved surgical accuracy in various departments. Here, we present the application of mixed reality-assisted surgery and a guiding marker in the case of small retroperitoneal metastasis of uterine cancer.

Case presentation: A 67-year-old female with a history of uterine cancer had a retroperitoneal metastasis in the lateroconal fascia near the right diaphragm, measuring 2 cm and infiltrating the peritoneum. We performed precise surgical planning using the preoperative mixed reality software "Holoeyes" on a head-mounted display called HoloLens2. Novel techniques, including ultrasonography-guided placement of a guiding marker and strategic port-site placement facilitated by HoloLens2, ensured accurate tumor identification and laparoscopic resection with minimal blood loss and no intraoperative complications.

Conclusion: The use of mixed reality-assisted surgery and a guiding marker effectively enhanced the precision of retroperitoneal tumor resection.

Keywords: Holoeyes; mixed reality; retroperitoneal.

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Conflict of interest statement

Mikio Sugimoto is an Editorial Board member of International Journal of Urology and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Figures

Fig. 1
Fig. 1
(a) A contrast‐enhanced CT scan shows retroperitoneal metastasis in the lateroconal fascia close to the right diaphragm, partly infiltrating the peritoneum. The tumor measured 2 cm in size and showed contrast enhancement. (b–d) STL data (3D data) were produced using the workstation. (b–d) 3D data from the skin to inside the body (the green sphere indicates the tumor).
Fig. 2
Fig. 2
(a) A guiding marker was placed 1 cm caudal to the tumor within the flank pad under echo guidance (arrow indicates marker). (b) The guiding marker comprises a nylon thread and a stainless marker at the tip. The thread of the guiding marker was observed in the surgical field (arrow indicates marker). (c) The surgical team identified the port sites using the HoloLens2 HMD. (d) The placed ports. (e) The port was placed 1.5 cm caudal to our usual laparoscopic nephrectomy port (the pink spheres) (the green sphere indicates the tumor. The black sphere indicates the port position in the present case).
Fig. 3
Fig. 3
(a) The guiding marker placed on the flank pad within the surgical field was observed on a fiberscope (arrows indicate the thread of the guiding marker). (b) The surgical team used HoloLens2 to identify the location of the tumor again. (c) The retroperitoneal tumor was identified using the HoloLens2 HMD. The blue sphere behind the 11th rib indicates the tumor.
See this image and copyright information in PMC

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