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J Reconstr Microsurg
DOI: 10.1055/s-0044-1788548
Original Article

HoloDIEP—Faster and More Accurate Intraoperative DIEA Perforator Mapping Using a Novel Mixed Reality Tool

Fabian N. Necker 
1   Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California
2   Digital Anatomy Lab, Faculty of Medicine, Institute of Functional and Clinical Anatomy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
3   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
,
David J. Cholok 
3   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
,
Marc J. Fischer
1   Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California
,
Mohammed S. Shaheen
3   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
,
Kyle Gifford 
4   Department of Radiology, 3D and Quantitative Imaging, Stanford University School of Medicine, Stanford, California
,
Michael Januszyk 
3   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
,
Christoph W. Leuze 
1   Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California
,
Michael Scholz 
2   Digital Anatomy Lab, Faculty of Medicine, Institute of Functional and Clinical Anatomy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
,
Bruce L. Daniel 
1   Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California
,
Arash Momeni 
3   Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California
› Author Affiliations Funding Information F. Necker and Dr. M. Scholz have been funded by BaCaTeC - Bavaria California Technology Center, Erlangen, Germany (funded by the State of Bavaria, Bavarian State Ministry for Science and Art). Project title: Patient-specific visualization of (vascular) anatomy in mixed reality for interventional and surgical planning; start of funding: 1 January 2022. F. Necker is a recipient of a scholarship at the Graduate Center of the Bavarian Research Institute for Digital Transformation - bidt (Munich, Germany) funded by the Bavarian State Ministry for Science and Art. There were no other sources of funding for the other authors.
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Abstract

Background Microsurgical breast reconstruction using abdominal tissue is a complex procedure, in part, due to variable vascular/perforator anatomy. Preoperative computed tomography angiography (CTA) has mitigated this challenge to some degree; yet it continues to pose certain challenges. The ability to map perforators with Mixed Reality has been demonstrated in case studies, but its accuracy has not been studied intraoperatively. Here, we compare the accuracy of “HoloDIEP” in identifying perforator location (vs. Doppler ultrasound) by using holographic 3D models derived from preoperative CTA.

Methods Using a custom application on HoloLens, the deep inferior epigastric artery vascular tree was traced in 15 patients who underwent microsurgical breast reconstruction. Perforator markings were compared against the 3D model in a coordinate system centered on the umbilicus. Holographic- and Doppler-identified markings were compared using a perspective-corrected photo technique against the 3D model along with measurement of duration of perforator mapping for each technique.

Results Vascular points in HoloDIEP skin markings were −0.97 ± 6.2 mm (perforators: −0.62 ± 6.13 mm) away from 3D-model ground-truth in radial length from the umbilicus at a true distance of 10.81 ± 6.14 mm (perforators: 11.40 ± 6.15 mm). Absolute difference in radial distance was twice as high for Doppler markings compared with Holo-markings (9.71 ± 6.16 and 4.02 ± 3.20 mm, respectively). Only in half of all cases (7/14), more than 50% of the Doppler-identified points were reasonably close (<30 mm) to 3D-model ground-truth. HoloDIEP was twice as fast as Doppler ultrasound (76.9s vs. 150.4 s per abdomen).

Conclusion HoloDIEP allows for faster and more accurate intraoperative perforator mapping than Doppler ultrasound.

Keywords

HoloLens - breast reconstruction - DIEA - CTA - 3D-rendering - abdominal flaps

Supplementary Material



Publication History

Received: 26 February 2024

Accepted: 22 June 2024

Article published online:
22 July 2024

© 2024. Thieme. All rights reserved.

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