Introduction: The field of surgery is constantly looking at ways to improve efficiency, patient outcomes, operating times and techniques and this has seen the increasing use of technology in surgery such as advances in imaging technology and use of robotics. Virtual reality completely replaces the real work with a simulated one while Augmented Reality (AR) overlays the virtual information onto the real world thus augmenting it in real time
Aim: To develop processes in the creation of a surgical navigation tool using a head mounted see-through AR device for real-time visualisation of the patient’s own computed tomography (CT) images during surgery as a holographic display. This could then be rendered onto the operative field for deep inferior epigastric artery (DIEP) flap for microvascular autologous breast reconstruction.
Methods: Pre-operative CT angiograms (CTA) using standardised protocols for DIEP flap breast reconstruction performed at a single institution were used. The DICOM files were extracted and imported into a converting software. Data that was not useful or not needed was then removed from the CTA and imported into a volume renderer to improve the quality of the image for analysis. After analysis of multiple CTA files, useful layers demonstrating tissue planes was able to be rendered.
Results: Standard CTA DICOM data can be converted into high quality 3D volumes and rendered as multiple layers displaying the intra-muscular course of the deep inferior epigastric artery, its sub-fascial course, emergence of suitable perforators through the rectus abdominis sheath as well as the superficial inferior epigastric (SIEA) arterial system. This 3D data can then be further converted into figures for 3D printing and 3D mesh structures for use with see-through AR head mounted devices, making it possible to ‘see-through’ the skin on the operating table.