The technology of augmented and mixed reality (AR/MR) is useful in various areas of modern surgery. We considered the use of augmented and mixed reality technologies as a method of preoperative planning and intraoperative navigation in abdominal cancer patients. Practical use of AM/MR raises a range questions, which demand suitable solutions. The difficulties and obstacles we encountered in the practical use of AR/MR are presented, along with the ways we chose to overcome them. The most demonstrative case is covered in detail. The three-dimensional anatomical model obtained from the CT scan needed to be rigidly attached to the patient’s body, and therefore an invasive approach was developed, using an orthopedic pin fixed to the pelvic bones. The pin is used both similarly to an X-ray contrast marker and as a marker for augmented reality. This solution made it possible, not only to visualize the anatomical structures of the patient and the border zone of the tumor, but also to change the position of the patient during the operation. In addition, a noninvasive (skin-based) marking method was developed that allows the application of mixed and augmented reality during operation. Both techniques were used (8 clinical cases) for preoperative planning and intraoperative navigation, which allowed surgeons to verify the radicality of the operation, to have visual control of all anatomical structures near the zone of interest, and to reduce the time of surgical intervention, thereby reducing the complication rate and improving the rehabilitation period.

Augmented reality (AR) is a promising area in microsurgical treatment of cerebrovascular pathologies that can significantly facilitate preoperative planning and intraoperative understanding of anatomy. Objective. To describe AR-assisted neuronavigation in microsurgical treatment of intracranial aneurysms, arteriovenous malformations and cavernomas; to evaluate accuracy and applicability of AR-assisted neuronavigation. Material and methods. The study involved 22 patients with cerebral aneurysms, arteriovenous and cavernous malformations. Microsoft Hololens 2 HMD glasses and «Medgital» software for AR navigation were used. Accuracy of registration (TRE and FRE) and time for preoperative preparation were evaluated. Results. Mean TRE when using QR code was 0.6±0.2 cm, when combining through craniometric points — 1.4±0.6 cm. Time for preoperative image processing was 24.7±5.1 minutes, application setup in the operating theatre — 1.6±0.2 minutes. Combination using QR code provided higher accuracy of registration compared to craniometric points. AR-assisted navigation improved visualization and planning of surgeries for aneurysms, arteriovenous malformations, microvascular anastomoses and cavernous angiomas. Conclusion. AR-assisted navigation is an innovative method with specific advantages that can potentially improve microsurgical treatment of cerebrovascular diseases. Further research is needed to confirm these findings and develop AR technology in neurosurgery.

Surgical treatment of locally spread tumors in pelvic organs remains an urgent and complicated oncological problem. The recurrence rate after radical treatment ranges from 15.1% to 45.2%. The key to successful and safe surgical intervention lies in meticulous planning and intraoperative navigation, including the utilization of augmented reality (AR) technology. This paper presents the experience of clinically testing an AR technology application algorithm in the surgical treatment of 11 patients. The main stages of the algorithm are described. Radical operations incorporating intraoperative AR technology with favorable outcomes were performed on eight patients. One patient underwent a palliative intervention, while two patients did not undergo surgery. The testing of the algorithm for the application of AR technology in the surgical treatment of primary and recurrent pelvic tumors demonstrated both a technical possibility and reproducibility of this algorithm and the AR technology itself in clinical practice.

Background: External ventricular drainage (EVD) is a critical neurosurgical procedure for managing conditions. Despite its widespread use, EVD placement is associated with specific risks, as improper catheter positioning can lead to severe complications. Recent advancements in augmented reality (AR) technology present new opportunities to improve the precision and safety of surgical interventions. Methods: This study presents a new AR-assisted approach for EVD placement, utilizing the Microsoft HoloLens 2 and the Medgital software. We conducted a clinical trial involving three patients requiring EVD due to acute hydrocephalus or subarachnoid hemorrhage. The study adhered to ethical standards and was approved by an Ethics Committee, with informed consent obtained from all participants. Two alignment methods were employed: cranial landmark-based and QR code-based alignment. Preoperative imaging facilitated the creation of patient-specific 3D models, which were aligned with the patient’s anatomy during surgery. Results: The results suggest that AR navigation may improve the accuracy of catheter placement. In the first case, EVD was placed with a deviation of 2.3 mm from the planned trajectory, while the second and third cases achieved deviations of 1.5 mm and 0.5 mm, respectively. These results indicate the potential effectiveness of the AR system. Importantly, no postoperative complications were observed, suggesting the safety of the AR-guided approach. Conclusion: This study suggests the viability of AR-assisted navigation in neurosurgical practice, particularly for EVD placement. The promising results support further exploration and integration of AR technologies in surgical settings, aiming to improve patient outcomes and procedural efficiency in neurosurgery.

Objective. To evaluate the effectiveness of augmented reality (AR) as a neuronavigation method in performing extracranial-intracranial microanastomosis. Material and methods. This study included a patient who underwent an extracranial-intracranial microanastomosis with proximal clipping of a giant fusiform partially thrombosed aneurysm of the right middle cerebral artery. AR technology using Microsoft Hololens 2 augmented reality glasses and software from MEDGITAL LLC was utilized for preoperative planning and intraoperative navigation. Anatomical data from preoperative angiography were integrated into a 3D matrix and overlaid onto the surgical field. Accuracy of marking, time, and ease of use were evaluated. Results. The use of AR significantly improved the visualization of the donor vessel (STA) during its dissection. AR also enhanced the precision of performing the craniotomy above the recipient vessel. No intraoperative or postoperative complications occurred. Conclusion. AR technology demonstrated its effectiveness in preoperative marking and performing extracranial-intracranial microanastomosis. It facilitates artery identification and potentially reduces the risk of complications associated with their injury. Further studies should include comparisons with traditional methods to definitively assess the advantages of AR.