Mixed Reality (Holography)-Guided Minimally Invasive Cardiac Surgery—A Novel Comparative Feasibility Study
Winn Maung Maung Aye, László Király, Senthil S. Kumar, Ayyadarshan Kasivishvanaath, Yujia Gao, Theo Kofidis · Journal of Cardiovascular Development and Disease · 2025
The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient’s computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens® 2 differed by one intercostal space from the marking made using a conventional surgeon’s mental reconstructed image from the patient’s preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety.