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CC BY 4.0 · Endoscopy 2025; 57(S 01): E923-E924
DOI: 10.1055/a-2639-4693
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Intraoperative mixed reality support for endoscopic submucosal dissection of a large laterally spreading tumor in the rectum

Authors

  • Takeshi Uozumi

    1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)

  • Maki Sugimoto

    2   Innovation Lab, Teikyo University Okinaga Research Institute, Tokyo, Japan

  • Yasuhiko Mizuguchi

    1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)

  • Naoya Toyoshima

    1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)

  • Seiichiro Abe 

    1   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Ringgold ID: RIN68380)
    3   Division of Science and Technology for Endoscopy, National Cancer Center Hospital, Tokyo, Japan

  • Ryuji Hamamoto

    4   Division of Molecular Modification and Cancer Biology, National Cancer Center Research Institute, Tokyo, Japan (Ringgold ID: RIN13543)

  • Yutaka Saito

    5   Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

Gefördert durch: Bringing the gap between R&d and the Ideal society and Generating Economic and social value (BRIDGE) NCC MIRAI project
Gefördert durch: NCC MIRAI project
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Mixed reality is a novel technology that adds digital elements to the real world to blend virtual and physical experiences. Recently, mixed reality has gained attention as a real-time intraoperative support modality that enhances the operator’s spatial awareness for detecting organs and vessels [1]. Colorectal endoscopic submucosal dissection (ESD) is widely used as a minimally invasive treatment; however, owing to its technical difficulty, endoscopists experience various levels of stress during the procedure regarding the possibility of perforation and bleeding. Mixed reality might help endoscopists accurately comprehend anatomical structures during ESD, preventing intraoperative adverse events without endoscopist stress. This is the first case report of intraoperative mixed reality support during colorectal ESD.

A 71-year-old woman was diagnosed with a 70-mm early colorectal cancerous tumor (cTis-T1a) in the lower rectum, and ESD was planned ([Fig. 1]). Preoperative three-phase contrast-enhanced computed tomography (CT) images revealed three thick, penetrating vessels underneath the tumor. Before ESD, standard triangulated language formats of the rectum, vessels, and tumor were created from CT images and uploaded to the Holoeyes MD system (Holoeyes Inc., Tokyo, Japan) to create virtual three-dimensional (3D) models [2].

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Fig. 1 Preoperative and intraoperative images. a 70-mm 0-Is+IIa lesion (laterally spreading tumor, granular type: LST-G nodular mixed type) located in the lower rectum. b Japan Narrow Band Imaging Expert Team: JNET Type2A. c Peripheral intravenous therapy applied. d 3D model (red: artery; blue: vein; green: tumor). e Thick penetrating vessels are detected underneath the tumor during endoscopic submucosal dissection.

ESD was performed using a see-through head-mounted display (HoloLens; Microsoft Corporation, Redmond, Washington, USA) that enabled the superposition of a CT-based 3D model onto the real world ([Fig. 2]). During ESD, as recognized in the CT-based 3D MR model, we identified the penetrating vessels and safely avoided major bleeding without stress ([Video 1]). ESD was completed without any intraoperative adverse events, and the pathological diagnosis was intramucosal cancer with R0 resection.

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Fig. 2 The see-through head-mounted display.
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Intraoperative mixed reality support for endoscopic submucosal dissection.Video 1

In this case report, the intraoperative mixed reality support contributed to promptly comprehending the spatial relationships between the tumor and thick penetrating vessels, and we successfully avoided intraoperative bleeding without stress. The intraoperative mixed reality support might be a next-generation ESD support modality.

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Artikel online veröffentlicht:
20. August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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