Dissecting Superficial Inferior Epigastric Veins Using a Tablet Navigation Device

Abstract

A preoperative understanding of the running pattern of blood vessels is important to safely raise flaps during surgery. The vascular anatomy from medical images indicates the entire vascular course and several perforator positions. We developed a navigation device using augmented reality technology to observe the running pattern of the vasculature collected from computed tomography angiography. Our navigation system was comprised of a tablet device (Surface Pro7), an L-shaped marker, and a custom-made software installed on the tablet device. The tablet device recognized three black and white circles, and generated vascular images of the patient's body that was filmed through the back camera of the device. Four deep inferior epigastric perforator (DIEP) artery flaps wherein the superficial inferior epigastric veins (SIEVs) were catheterized for flap monitoring, 2 DIEP flaps with superdrainage through the SIEV, and 1 superficial inferior epigastric artery flap were included in this study. Twelve SIEVs were safely dissected based on the SIEV markings of our navigation device. Despite an error of less than 1 cm, bilateral SIEVs were easily identified on the cranial and caudal sides using the image overlay system. Our device successfully navigated the superficial vascular dissection. In the future, we would like to apply this system to deep structure targets.

Fig. 1.

Components of the navigation system. The navigation system contains a tablet device (Surface Pro7), and an L-shape marker.

Fig. 2.

The SIEV tracing. A, Blue dots represent the SIEV according to the tablet device navigation. B, Black lines represent the SIEV according to the ultrasound. There was an error of a few millimeters between our device and ultrasound.

Fig. 3.

DIEP flap dissection. Both of the SIEVs were preserved on caudal and cranial side.