ARAS (Augmented reality assisted surgery): A surgical planning tool for penile prosthesis

Authors: Rafael E. Carrion Jr, Raul Fernandez-Crespo, Gerard D. Henry, Jay Simhan, Anand Shridharani, Rafael E. Carrion, Tariq S. Hakky

Key Words: Augmented reality (AR)- Augmented reality assisted surgery (ARAS)- Optical head mounted displays (OHMD) - penile prosthesis (PP) - Surgical planning

ARAS uses superimposed images in physicians' fields to integrate common elements of surgical planning process in more advanced detail. OHMD has proven effective in clinical and operative settings and can be used as an AR interface for surgical planning. We used this tool to plan surgery for a patient who received a malfunctioning penile implant. To plan this procedure. We used the Hololens 2 developer edition holographic windows for business (OS 203481447). We used ApoQlar VSI version 1.8 to load CT Scan DICOM images of the patient's deflated penis. We obtained patient consent, and his information was expunged. Three surgeons were equipped with a HoloLens unit and installed ApoQlar VSI on each unit. Each surgeon was then meshed into the VSI application on their respective HoloLens with the primary surgeon to evaluate the case and to preplan surgical procedure. With a 3D scalpel, we examine a cross-section of CT scan images from whatever perspective might find it helpful. We detected aneurysmal dilation of the cylinder and marked it on 3D shapes. Additionally, we load virtually a Furlow and reservoir unit and manipulate them in 3D, placing them in their respective positions to depict the surgical procedure accurately. Measurements were made to help plan virtually PP devices placement, allowing accurate visualization and preplanning of the procedure. We performed a penile prosthesis revision case with an infrapubic approach, reduction corporoplasty, and a Tutoplast grafting. We deflated the left cylinder, which had a proximal aneurysmal defect before its removal. A new cylinder was placed in the left corpora after the corpora were plicated. Our surgical time was 32 minutes, and blood loss was quantified as 25mLs. We demonstrate the first example of ARAS as a planning tool for penile prosthesis surgery and how this technology could assist surgeons in the future.

Acknowledgement: Coloplast helped fund the study

Disclosures: Rafael Carrion Jr-none; Raul Fernandez-Crespo-none; Gerard D. Henry-consultant Boston Scientific, Coloplast, Microgen, Signati; Jay Simhan-consultant Coloplast; Anand Shridharani, Rafael E. Carrion-Consultant Coloplast, Boston Scientific, Endo, Rigicon; Tariq S. Hakky-Consultant Signati, Coloplast.