Enhancing Perioperative Outcomes of Pancreatic Surgery with Wearable Augmented Reality Assistance System: A Matched-Pair Analysis

Abstract

Objective: The present study aimed to evaluate the safety of the first wearable augmented reality assistance system (ARAS) specifically designed for pancreatic surgery and its impact on perioperative outcomes.

Background: Pancreatic surgery remains highly complex and is associated with a high rate of perioperative complications. ARAS, as an intraoperative assistance system, has the potential to reduce these complications.

Methods: This prospective, single-center study included 20 patients who underwent pancreatic surgery using ARAS. These patients were matched in a 1:3 ratio with 60 patients from our retrospective data who underwent standard pancreatic resection. Matching variables were selected based on factors associated with poor intraoperative outcomes.

Results: A higher proportion of patients in the ARAS group were diagnosed with borderline resectable pancreatic cancer and received neoadjuvant chemotherapy (20.0% vs 6.7%, P = 0.085). Additionally, more patients in the ARAS group required arterial resection compared with the control group (15.0% vs 0.0%, P = 0.002). Nevertheless, the ARAS group had a significantly shorter operative time (246 vs 299 minutes, P = 0.004) and required significantly fewer intraoperative blood transfusions (0.0 ± 0.0 vs 0.5 ± 1.4 units, P = 0.014). None of the patients in the ARAS group had positive resection margins (0.0% vs 20.0%, P = 0.045). Furthermore, patients in the ARAS group experienced a significantly shorter hospital stay (13.8 ± 6.6 vs 17.9 ± 8.2 days, P = 0.046).

Conclusions: ARAS is a safe and effective assistance system for pancreatic surgery, offering superior perioperative outcomes compared with standard procedures.

Keywords: augmented reality; navigation system; pancreatectomy; surgical planning; wearable devices.

FIGURE 1.

Preoperative surgical planning using ARAS, which allows for detailed and customizable planning of the operation using the 3D model of the patient’s reconstructed peripancreatic structures (patient 1 underwent an Appleby procedure). CHA indicates common hepatic artery; HA, hepatic artery; GDA, gastroduodenal artery.

FIGURE 2.

The intraoperative phase of ARAS includes (A) supportive data that provides real-time information about the patient’s medical history and a DICOM viewer panel, and (B) in-situ visualizations and projections of the reconstructed 3D model during the operation. CHA indicates common hepatic artery; DICOM, Digital Imaging and Communications in Medicine; GDA, gastroduodenal artery; PV, portal vein.

FIGURE 3.

A, A sterilized marker is fixed onto the xiphoid process before beginning the laparotomy. To ensure accurate placement and 3D Model registration, the marker is positioned according to the distance from the jugular notch, aligning it with the end of the xiphoid process as determined by preoperative computed tomography scans. B, Marker-based tracking is then used, with the entry point of the left renal vein into the inferior vena cava serving as a second registration point after performing the Kocher maneuver.