Novel navigation system by augmented reality technology using a tablet PC for hepatobiliary and pancreatic surgery

Background: We previously developed an image-guided navigation system (IG-NS) using augmented reality technology for hepatobiliary and pancreatic (HBP) surgery. This system superimposed a 3D model onto a stereoscope-captured surgical field (i.e., the scope method). Unfortunately, this method requires an expensive stereoscope, surgeons have to shift their eyesight away from the surgical field, and the method has poor controllability. Therefore, an IG-NS using a tablet PC (i.e., the tablet method) was developed. The aim of the current study is to evaluate the efficiency of this novel method. Methods: We studied 9 patients, for whom a 3D model was created from computed tomography images. After registration was performed, the 3D model was superimposed onto the surgical field, which was captured by the tablet PC's camera. Results: The IG-NS could be applied with very little time lag. The visibility and controllability of the tablet method were superior to those of the scope method. It was especially useful in surgery for multiple metastatic liver carcinoma due to easy localization of the position of the carcinomas and vessels. Conclusions: We successfully developed the tablet method and tested it in a clinical setting. This system may contribute to surgical efficacy and improve the educational effects.