title: Use of augmented reality in laparoscopic gynecology to visualize myomas.
abstract: OBJECTIVE
  To report the use of augmented reality (AR) in gynecology.
  
  
  METHODS
  AR is a surgical guidance technology that enables important hidden surface structures to be visualized in endoscopic images. AR has been used for other organs, but never in gynecology and never with a very mobile organ like the uterus. We have developed a new AR approach specifically for uterine surgery and demonstrated its use for myomectomy.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  Three patients with one, two, and multiple myomas, respectively.
  
  
  METHODS
  AR was used during laparoscopy to localize the myomas.
  
  
  METHODS
  Three-dimensional (3D) models of the patient's uterus and myomas were constructed before surgery from T2-weighted magnetic resonance imaging. The intraoperative 3D shape of the uterus was determined. These models were automatically aligned and "fused" with the laparoscopic video in real time.
  
  
  RESULTS
  The live fused video made the uterus appear semitransparent, and the surgeon can see the location of the myoma in real time while moving the laparoscope and the uterus. With this information, the surgeon can easily and quickly decide on how best to access the myoma.
  
  
  CONCLUSIONS
  We developed an AR system for gynecologic surgery and have used it to improve laparoscopic myomectomy. Technically, the software we developed is very different to approaches tried for other organs, and it can handle significant challenges, including image blur, fast motion, and partial views of the organ.
authors.affiliation: Department of Gynecologic Surgery, Centre Hospitalier de l'Université Estaing Clermont-Ferrand, Clermont-Ferrand, France; ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France. Electronic address: micolas.bourdel@gmail.com.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.affiliation: ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France.
authors.forename: Toby
authors.initials: T
authors.lastname: Collins
authors.affiliation: ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pizarro
authors.affiliation: ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France.
authors.forename: Clement
authors.initials: C
authors.lastname: Debize
authors.affiliation: Department of Gynecologic Surgery, Centre Hospitalier de l'Université Estaing Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Grémeau
authors.affiliation: ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Bartoli
authors.affiliation: Department of Gynecologic Surgery, Centre Hospitalier de l'Université Estaing Clermont-Ferrand, Clermont-Ferrand, France; ALCoV, Image Science for Interventional Techniques (Unité Mixte de Recherche 6284, Centre National de la Recherche Scientifique), University of Auvergne, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D018231:Leiomyomatosis / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000295:instrumentation; D047368:Tumor Burden; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Gynecologic surgery; MRI; augmented reality; laparoscopy; myomectomy