Intraoperative Surgical Guidance for DIEP Flap Harvest using Augmented Reality

SUMMARY: Augmented reality (AR) systems for surgical navigation provides the capability to project preoperative CT scans and segmented anatomical structures directly into the surgeon’s field of view, along with virtual displays akin to traditional monitors. Utilizing the Meta Quest 3 consumer AR headset, we found that it can achieve clinically acceptable accuracy in surgical navigation for deep inferior epigastric perforator (DIEP) surgeries. Notably, the Quest 3 can operate independently thanks to a novel registration technique employing hand tracking, suitable for use in sterile environments. The DIEP flap is a widely favored option for autologous breast reconstructions. Intraoperatively, the perforator arteries are selected to maximize tissue perfusion and minimize donor site morbidity. Conventionally, preoperative CT angiograms are used to locate perforators and visualize vessel courses, thus reducing DIEP flap harvest time and complication rates. Though, there are currently very limited means to reliably translate information found on preoperative imaging for use in the operating theater. The Meta Quest 3 was trialed in three DIEP flap surgeries by displaying segmented deep inferior epigastric arteries and DIEP arteries during preoperative and intraoperative phases of surgery. The AR projections facilitated the visualization of the DIEP arteries and efficient pedicle dissection by guiding the placement and length of the fascial incision. Furthermore, this work supports the hypothesis that AR will improve flap design, reduce harvest time, and improve safety during DIEP flap harvesting.