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Visceral

LIVER CANCER

Global Problem.
Local Solution.

Primary liver cancer is the second most common cause of cancer mortality and the seventh most frequently occurring cancer in the world1.

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LIVER CANCER

Worldwide Reality

In the USA, the liver cancer incidence rates have more than tripled in recent years, while the death rates have more than doubled during this time2.

And risk of the cancer recurrence following resection is up to 70% in 5 years3.

There are 9,500 liver cancer cases per year in Germany alone and almost 8,000 deaths4.
‍
In UK, the survival rate for 5 or more years is 13%5.

In Asia, Liver Cancer is the third most common type of cancer6.

In addition, colorectal, lung, pancreas, and esophageal cancer are often responsible for neoplasms in the liver7.
Accurate Liver Tumor Location Is One Of The Biggest Challenge In Visceral Surgery

Traditional image-guided surgery (IGS) requires doctors to match patient-specific preoperative images with intraoperative patients to guide tumor cutting.

Complexity of the process due to the challenge of determining the cutting margin.

The doctor needs to switch the line of sight between the patient and the display screen, resulting in a prolonged operation time.

preoperative planning - visceral focus

Expected Benefits of
Mixed Reality

  • Improves liver resection planning and shortens the time of the surgery
  • Easier/ faster detection of veins variations – patient-specific structures
  • Improves resection margins
  • Improves oncological outcomes
visceral use cases

VSI HoloMedicine® Application

Anatomic and non-anatomic resection as well as laparoscopic surgery are enhanced with the implementation of VSI HoloMedicine® application*.

  • Segment a liver CT and interact with a 3D holographic object in the Medical Metaverse
  • Plan a resection with the 3D planning tools
  • Interact with the 3D object to achieve the desired visualization (change size, slice through the object, place markers, change transparency, move anatomical structures apart from each other, etc.)
  • Discuss a case over distance through our collaboration tools
  • Stream a surgery to hundreds of students that are sitting at home amazed by the innovation that AR brings
  • Avoid having multiple healthcare professionals in a minimally invasive surgery by streaming the laparoscope view**

*To be used according to the intended use only.
**Requires additional hardware manufactured by apoQlar: Streamer Box

Fig. 1: Collaborate together via Shared Experience as Avatars or via direct MS Teams integration
Doctor Story

Pius-Hospital Case

Fig. 2: Medical Collaboration in the Medical Metaverse
Fig. 3: Working Together Remotely as Avatars in the Medical Metaverse
With the help of the 3D holograms, we can capture the complex vessel and organ anatomy of the specific patient much faster with realistic depth perception. It simplifies anatomical orientation/planning and improves communication within the surgical and interdisciplinary teams. In addition, we can overlay these images onto the real patient and get a better spatial understanding of the tumor position. Especially in complex surgeries, this will allow us to operate more safely.
Prof. Dr. Dirk Weyhe
Director of the Clinic for General and
Visceral Surgery
Pius-Hospital, OLDENBURG, Germany

VSI HoloMedicine®
Expected Benefits

To visualize a complex case with several tumors present, VSI HoloMedicine® was utilized at Pius-Hospital as a complementary tool along with conventional CT-/MRI imaging benefiting in:

01. Accurate Tumor Location

The combination of conventional CT-/MRI scans and 3D imaging in Mixed Reality allowed surgeons to locate tumors more accurately and prevent healthy tissues to be affected.

02. Reduced Recovery Times

Faster healing process due reduced surgical trauma and improved postoperative condition.

03. Intuitive Visualization

Ability to faster & better visualize and appreciate complex vessel anatomy in Mixed Reality.

04. You Can Not Plan For What You Can Not See

Increased surgeon confidence before the first cut: you can not plan for what you can not see. Without the 3D segmented view of such a complex case in Mixed Reality, many surgeons are reluctant to go through the procedure.

05. Making Life Possible

Reevaluating a palliative designation and ultimately supporting the doctor in saving a patient’s life9.

Medical Mixed Reality gives users the ability to move beyond the realm of 2D and into a more immersive 3D experience.

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VSI HoloMedicine®

Further Developments at Pius-Hospital

System implementation in routine workflows in order to create and sustain an effective clinical ecosystem.

Standardization of the Mixed Reality Preoperative Planning approach with various surgical fields.

Work over distance: connect with colleagues globally for specific case consultations, tumor boards or remote Surgical Planning.

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Doctor Story

Visceral Surgery

Case description:
For complex operations such as visceral surgery, VSI HoloMedicine® is a new and very innovative way of improving the quality of medicine through 3D representation.

The workflow of uploading imaging and transforming it into a holographic interactive medical data is carried out within a few minutes with simple and intuitive steps. The HoloLens connects with the cloud via Wi-Fi, which is implemented in the operating theatre.

The operation planning was carried out via CT with the administration of intravenous contrast medium. The main advantage of the VSI HoloMedicine® is rendering in the operating area, which supports the definition of the surgical routes.

The operations carried out in Kamp-Lintfort at the Lower Rhine Tumor Center are documented accordingly and have already shown advantages of preoperative planning. In the future, the operation is to be simulated in the interdisciplinary network/tumor conference and will also aid us in effectively educating patients. The 3D image was used for the operation on a patient with a tumor.

The advantage of VSI HoloMedicine® is particularly evident within complex resections in visceral surgery.
Fig. 4: 3D representation of the liver with a tumor
*For research purposes only.
Fig. 5: MRI placed on patient
*For research purposes only.
For me, rendering is the central element and a major advantage of VSI HoloMedicine®. The tumor is displayed three-dimensionally via the imported CT. The transparent patient images can significantly improve the quality of the surgery planning.
Prof. Dr. Gernot Kaiser
Chief Physician,
Center for General and Visceral Surgery,
St. Bernhard-Hospital, Germany
Benefits:

• Operation planning becomes more transparent for the patient through improved preoperative clarification and the patient is thus much better informed.
• Potential improvement of clinical care and surgical procedure.
• We see further possibilities for the future in the application in minimally invasive surgery.
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References:
1. McGlynn et al. (2021) Hepatology. 2021 January ; 73(Suppl 1): 4–13. doi:10.1002/hep.31288.
2. The American Cancer Society: Key Statistics About Liver Cancer, July 2022.
3. Erdmann F, Spix C, Katalinic A, et al. Krebs in Deutschland für 2017/2018. Robert-Koch-Institut, editor. Berlin: Robert-Koch-Institut; 2021.
4. AOK (2022): Krankenhausnavigator der AOK Suche (aok.de), July 2022.
5. Cancer Research UK (2022), Liver cancer statistics, Cancer Research UK.
6. AHCC (2022): About AHCC | SCRI - Singapore Clinical Research Institute, June 2022.
7. Horn SR, Stoltzfus KC, Lehrer EJ, Dawson LA, Tchelebi L, Gusani NJ, Sharma NK, Chen H, Trifiletti DM, Zaorsky NG. Epidemiology of liver metastases. Cancer Epidemiol. 2020 Aug;67:101760.
doi: 10.1016/j.canep.2020.101760. Epub 2020 Jun 17.
8. 3D medical object is a part of the VIVATOP (Versatile Immersive Virtual and Augmented Tangible OP) Research Project.
9. NDR Visite. Leberkrebs: Holomedizin liefert bei Operation 3-D-Bilder, May 2022: https://www.ndr.de/ratgeber/gesundheit/Leberkrebs-Holomedizin-liefert-bei-Operation-3-D-Bilder,leberkrebs114.html.

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