Augmented reality in cardiac surgery: first procedure in Italy using new technologies

Palermo, 25 January 2024 – For the first time in Italy, augmented reality is used in a cardiac surgery operating room to support a minimally-invasive procedure. This technology provides a three-dimensional organ reconstruction so surgeons can interact with a computer-generated hologram, simulating the procedure that will be performed on the patient. The intervention was performed at ISMETT-UPMC in Palermo, the center born from an international partnership between the Sicilian Region and UPMC (University of Pittsburgh Medical Center), by a team led by Prof. Francesco Musumeci, Senior Consultant in Cardiac Surgery at ISMETT.

The surgery was a minimally invasive left atrial appendage closure (the appendage is a small outpouching of the left atrium) carried out with the support of augmented reality. This procedure is indicated in patients with chronic atrial fibrillation and contraindications to anticoagulation therapy. The goal is to avoid a stroke due to the thrombi that can form inside the appendage. The procedure is usually performed inserting a percutaneous umbrella occluder through a vein in the leg that opens at the opening of the appendage, occluding it completely. “In our case,” explained Professor Francesco Musumeci, “due to a congenital obstruction of the inferior vena cava in a thrombophilic patient, we decided to intervene surgically using a minimally invasive access. ISMETT’s research laboratory directed by Prof. Salvatore Pasta and focusing on the development of augmented and virtual reality in the medical field, stimulated us to use these technologies. The objective was to assess the contribution of the technology available for this type of surgery in terms of precision and efficiency.”

Augmented reality is an interactive experience that enhances the real world with computer-generated perceptual information from images of diagnostic tests (e.g., CT, MRI and US) and allows a 3D simulation of reality with which surgeons can interact. These real time, interactive 3D images allow a better analysis of the anatomy. “In this particular case,” explained Salvatore Pasta, professor at the University of Palermo seconded at ISMETT, “with augmented reality the object initially reconstructed from the CT scan was projected in the OR on the patient, improving the surgeon’s perception on the treatment.” Prof. Pasta collaborates with ISMETT following an agreement between the Department of Engineering of the University of Palermo and ISMETT in the scope of cardiovascular research. The semi-transparent screen of the visor allows to overlay digital content in real time on the real environment. Using gestures to manipulate the holographic images inside the visor and having a view of the OR field, the surgeon can simulate the procedures he will perform optimizing efficiency and minimizing the risks.

The hologram of the patient’s chest and heart was reconstructed from the CT scan and on this 3D reconstruction a simulation was done that allowed to plan the surgery focusing on two important aspects: the entry point in the chest wall for the appendage closure system, and the anatomy of the appendage for correct positioning of the closing system.

“In the future augmented and virtual reality will play an increasingly important role in surgery,” said Prof. Musumeci, “providing support to planning procedures and better training opportunities for young surgeons. The intervention carried out at ISMETT is the first of this type ever performed in Italy. The outcome was excellent and the patient was discharged a few days after surgery.”