American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Augmented reality poised to transform surgical practice

OCTOBER 25, 2017
Clinical Congress Daily Highlights, Wednesday First Edition

In the last 60 years, the same advances that have transformed every American’s living room have also influenced the operating room, from the introduction of color television to the evolution of high definition (HD) displays, and the recent emergence of ultra-HD 4K video.

Even with vast improvements in resolution, however, the fundamental technology used in white light–guided procedures has not really changed over the last 50 years, said Steven D. Schwaitzberg, MD, FACS. But there are transformative improvements on the horizon, particularly in how computer technology can enhance an image.

“I think what we’re going to see in the advances of white light visualization is less about the resolution and what can we do to process the image to add value to it,” said Dr. Schwaitzberg, professor and chairman, Department of Surgery, University at Buffalo, NY, during a Wednesday panel session.

Augmented reality allows a computer-generated image to be superimposed on a user’s view of the real world, providing a composite image. This technology might allow a surgeon to peer into a patient’s body without making an incision, helping to plan an operation in advance or guide a procedure in progress.

Silvana Perretta, MD, IRCAD (Research Institute against Digestive Cancer) France, gave an overview of recent advances in augmented reality and the challenges yet to be overcome. One of these, she explained, is maintaining a properly composed image as patients breathe during an operation. The inherent movements of patients during an operation and of surgeons as they manipulate the body are challenges that scientists developing surgical augmented reality technology are still working to address.

Beyond augmented reality, other visualization technologies continue to evolve. There is growing evidence for the use of fluorescence cholangiography in laparoscopic cholecystectomies, for example, to provide better delineation of the bile duct during resection.

“Fluorescent cholangiography is safe and in small studies it’s been shown to be efficacious, and there is some optimism that may help improve visualization and thereby prevent bile duct injury,” said L. Michael Brunt, MD, FACS, Washington University in St. Louis, MO. But Dr. Brunt went on to stress that more studies are needed to support wider adoption for regular use in cholecystectomies.

Florescent imaging also has applications in cancer. Michael Bouvet, MD, FACS, University of California San Diego, presented emerging research on the use of fluorescently tagged probes to better identify cancer tissue as well as to track how anti-cancer drugs get into cancer tissue.

“Curative surgery is dependent on removing all primary and metastatic cancer cells, and techniques in fluorescence-guided surgery are emerging that selectively eliminate cancer cells,” he said.

Additional Information:
The Panel Session, Augmented Reality: Advances in Intraoperative Visualization, was held October 25, at the 2017 Clinical Congress of the American College of Surgeons in San Diego, CA. Program, webcast and audio information is available online at

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