HoloDIEP—Faster and More Accurate Intraoperative DIEA Perforator Mapping Using a Novel Mixed Reality Tool

Fabian N. Necker; David J. Cholok; Marc J. Fischer; Mohammed S. Shaheen; Kyle Gifford; Michael Januszyk; Christoph W. Leuze; Michael Scholz; Bruce L. Daniel; Arash Momeni

doi:10.1055/s-0044-1788548

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2025; 41(04): 318-329
DOI: 10.1055/s-0044-1788548

Original Article

HoloDIEP—Faster and More Accurate Intraoperative DIEA Perforator Mapping Using a Novel Mixed Reality Tool

Fabian N. Necker

¹Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California

²Digital Anatomy Lab, Faculty of Medicine, Institute of Functional and Clinical Anatomy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

³Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California

,

David J. Cholok

³Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California

,

Marc J. Fischer

¹Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California

,

Mohammed S. Shaheen

³Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California

,

Kyle Gifford

⁴Department of Radiology, 3D and Quantitative Imaging, Stanford University School of Medicine, Stanford, California

,

Michael Januszyk

³Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California

,

Christoph W. Leuze

¹Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California

,

Michael Scholz

²Digital Anatomy Lab, Faculty of Medicine, Institute of Functional and Clinical Anatomy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany

,

Bruce L. Daniel

¹Department of Radiology, Stanford IMMERS (Incubator for Medical Mixed and Extended Reality at Stanford), Stanford University School of Medicine, Palo Alto, California

,

Arash Momeni

³Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, California

› Author Affiliations

Abstract

Background Microsurgical breast reconstruction using abdominal tissue is a complex procedure, in part, due to variable vascular/perforator anatomy. Preoperative computed tomography angiography (CTA) has mitigated this challenge to some degree; yet it continues to pose certain challenges. The ability to map perforators with Mixed Reality has been demonstrated in case studies, but its accuracy has not been studied intraoperatively. Here, we compare the accuracy of “HoloDIEP” in identifying perforator location (vs. Doppler ultrasound) by using holographic 3D models derived from preoperative CTA.

Methods Using a custom application on HoloLens, the deep inferior epigastric artery vascular tree was traced in 15 patients who underwent microsurgical breast reconstruction. Perforator markings were compared against the 3D model in a coordinate system centered on the umbilicus. Holographic- and Doppler-identified markings were compared using a perspective-corrected photo technique against the 3D model along with measurement of duration of perforator mapping for each technique.

Results Vascular points in HoloDIEP skin markings were −0.97 ± 6.2 mm (perforators: −0.62 ± 6.13 mm) away from 3D-model ground-truth in radial length from the umbilicus at a true distance of 10.81 ± 6.14 mm (perforators: 11.40 ± 6.15 mm). Absolute difference in radial distance was twice as high for Doppler markings compared with Holo-markings (9.71 ± 6.16 and 4.02 ± 3.20 mm, respectively). Only in half of all cases (7/14), more than 50% of the Doppler-identified points were reasonably close (<30 mm) to 3D-model ground-truth. HoloDIEP was twice as fast as Doppler ultrasound (76.9s vs. 150.4 s per abdomen).

Conclusion HoloDIEP allows for faster and more accurate intraoperative perforator mapping than Doppler ultrasound.

Keywords

HoloLens - breast reconstruction - DIEA - CTA - 3D-rendering - abdominal flaps

Full Text

References

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Supplementary Material

Supplementary Material