Novel image monitoring system using a head‐mounted display for assistants in da Vinci surgery

摘要

The da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) allows an immersive 3-D view to be conferred to the operator through the surgeon console viewer.1 This image monitoring system has dramatically changed the way endoscopic images are viewed. However, only the console surgeon can use this image, and da Vinci surgery assistants still use a flat panel display. The HMD is a novel image monitor, which allows the wearer to monitor the sharp and high-contrast 3-D image in front of the eyes in an ergonomically efficient posture. As the quality of HMD has been dramatically improved in terms of wearability and resolution, modern HMD can be applied to various types of medical procedures. We previously showed the clinical application of the HMD in minimally invasive surgeries, transurethral procedures and ultrasonic examinations.2-7 Here, we developed a new distinctive image monitoring system for assistants in da Vinci surgery, by combining to the 3-D endoscope of the da Vinci surgical system (Fig. 1). We selected the HMD system (Sony Corporation, Tokyo, Japan) designed for medical use. The HMD system consists of HMD (HMM-3000MT) and an imaging processor unit (HMI-3000MT). HMM-3000MT is a 490-g binocular 3-D HMD composed of 0.7-inch organic light-emitting diode screens (resolution 1280 × 720 pixels) for each eye. The market price of this system is approximately ¥1.5 million. The imaging information obtained from the 3-D endoscope in the da Vinci surgical system is output to the HMD system through a 3-D control unit (Skyjet, Kobe, Japan). The imaging processor can split the input imaging information into two, and output split information into separate HMD. We used this image monitoring system as a personal imaging monitor for the assistant in robot-assisted laparoscopic radical prostatectomy (RALP). The case was a 66-year-old man who underwent RALP for clinically localized prostate cancer. Two assistants participated in the surgery. Each assistant wore the HMD during the operation including trocar insertion. The assistants could simultaneously and seamlessly share the same 3-D high-resolution view with the console surgeon. The total operative time was 288 min. The surgical procedure was successfully carried out, and there were no notable negative outcomes or incidents in the postoperative course. During the procedure, the assistants did not experience any HMD-related adverse effects. The HMD wearer could use direct vision by looking downward, which has little impact on the eyes’ field of view. However, the immersive environment of HMD could be a concern in regard to making the assistants unaware of the rapid motion of robotic arms. This is the first image monitoring system that uses HMD for assistants in da Vinci surgery. Although further study is required to show the actual benefits of the use of the HMD system, we believe this imaging system will make up for the loss of depth cue, and help assistants, especially novice urologists, technically facilitate RALP surgery. Furthermore, because of the affordable cost and the compact size of this HMD system, this imaging system can be applied to various types of procedures, and the cost-effectiveness of introducing this system is appropriate. Dr Kihara has received research funding from Sony Corporation (Tokyo, Japan), but the sponsor had no control over the interpretation, writing or publication of this work.