Patient Specific Augmented Reality in Extended Robotic Esophagus Resection for Type Ii Gastroesophageal Junction Adenocarcinoma

ABSTRACT

For several procedures augmented reality (AR) allowed surgeons to work by the realtime visual feedback of the surgery field during lockdown by the COVID-19 pandemic. Integrating AR into medical practice could play a key role for the improvement of the learning curve and lower the costs. Also renovate the educational model with one consensus regarding the financing of medical specialist degree. A global surgical model has not yet been achieved for type II adenocarcinoma of the gastro-esophageal junction (GEJ), while its incidence increases worldwide. Controversies exist about the type of resection. Minimally invasive surgery provides magnified anatomy that enables to perform dissection at the appropriate planes. This technique has made possible the standardization of surgery by 'concentric-structured model' for cancers arising in the middle part of esophagus. A patient specific model for GEJ will be conducted using the data of surgeries applied to the real anatomy with AR. The validity will be investigated, conforming the images. Dutch single-center cohort study have demonstrated that after gastrectomy a positive margin was more common. While, esophagus resection provided a more complete lymph node dissection. The CARDIA trial has shown that one of the strongest independent prognostic factors is the presence of metastatic lymph nodes. Importantly, patients with positive upper mediastinal lymph nodes had a poorer prognosis. Related to this, German group have shown feasibility and superiority of a fully robotic surgery allowing a highly controlled lymph node dissection. Also, Korean study reported favorable outcomes of full four-arm robotic compared to robotic surgery combined with open abdominal surgery. The increasing incidence of GEJ cancers, the different approaches and emerging new minimal invasive and robotic approach need a comprehensive anatomy concept of the type II GEJ. By having a global concept of surgical anatomy, surgery procedures can be performed consistently and standardized worldwide.