title: Robotic duodenopancreatectomy assisted with augmented reality and real-time fluorescence guidance.
abstract: BACKGROUND
  The minimally invasive surgeon cannot use 'sense of touch' to orientate surgical resection, identifying important structures (vessels, tumors, etc.) by manual palpation. Robotic research has provided technology to facilitate laparoscopic surgery; however, robotics has yet to solve the lack of tactile feedback inherent to keyhole surgery. Misinterpretation of the vascular supply and tumor location may increase the risk of intraoperative bleeding and worsen dissection with positive resection margins.
  
  
  METHODS
  Augmented reality (AR) consists of the fusion of synthetic computer-generated images (three-dimensional virtual model) obtained from medical imaging preoperative work-up and real-time patient images with the aim of visualizing unapparent anatomical details.
  
  
  RESULTS
  In this article, we review the most common modalities used to achieve surgical navigation through AR, along with a report of a case of robotic duodenopancreatectomy using AR guidance complemented with the use of fluorescence guidance.
  
  
  CONCLUSIONS
  The presentation of this complex and high-technology case of robotic duodenopancreatectomy, and the overview of current technology that has made it possible to use AR in the operating room, highlights the needs for further evolution and the windows of opportunity to create a new paradigm in surgical practice.
authors.affiliation: Hepato-Biliary and Pancreatic Surgical Unit, General, Digestive and Endocrine Surgery, IRCAD, IHU MixSurg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France, patrick.pessaux@chru-strasbourg.fr.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.forename: Luc
authors.initials: L
authors.lastname: Soler
authors.forename: Tullio
authors.initials: T
authors.lastname: Piardi
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000368:Aged; D004396:Coloring Agents; D005246:Feedback; D005260:Female; D005453:Fluorescence; D006801:Humans; D021621:Imaging, Three-Dimensional; D007208:Indocyanine Green; D016577:Pancreaticoduodenectomy / Q000379:methods*; D065287:Robotic Surgical Procedures; D025321:Surgery, Computer-Assisted / Q000379:methods*; D020535:Video-Assisted Surgery
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green