Innovative Robotic Liver Resection with Extended Reality for Both Navigation and Medical Education by Three Separate Surgeons.

Background: Although magnification is an advantage of robotic liver resection (RLR) as it enables precise surgery, the direction of parenchymal dissection, the vascular anatomy, and the tumor location can sometimes be lost. Extended reality (XR) has advantages over other navigation systems in terms of spatial awareness, sharing, and simplicity, and it also has the potential to overcome some of the limitations of RLR. METHODS: In this video, we demonstrate innovative RLR with XR by three separate surgeons. A 63-year-old male patient with two colorectal liver metastases in both segment 5 and 6 respectively, and subsegmentectomy was performed. A console surgeon executes parenchymal dissection with the clamp-crush method. An assistant surgeon uses CUSA to support parenchymal dissection, especially when securing the Glissonean pedicle. A nonsterilized XR surgeon projects the patient's own "hologram" onto the monitor, which is tilted in the same direction as the surgical field to check (1) the approximate tumor location, (2) the correctness of the dissection direction, and (3) the Glisson or hepatic veins that will appear.

Results: The three surgeons continuously share operative information, which also serves as an educational resource for residents and medical students. A total blood loss was 20 ml, and operation time was 178 min. The patient was discharged on postoperative day 8.

Conclusions: This is the world's first report of RLR with XR, which is an innovative approach that can contribute not only to real-time navigation, but also to medical education.