La réalité augmentée (RA) permet aux chirurgiens de bénéficier, durant l’intervention, d’une vision du champ opératoire enrichie par des données numériques, notamment d’imagerie (tumeurs, structures anatomiques). Cette technologie est utilisée en routine dans certaines spécialités mais de façon encore limitée en chirurgie hépatique en raison de la complexité à modéliser des déformations d’organes, en temps réel. Actuellement, de nombreuses équipes travaillent sur la mise au point d’une solution utilisable en pratique courante, pour pallier les difficultés de la navigation peropératoire au sein d’un organe opaque. Répertorier et analyser les séries rapportant les techniques de RA testées en chirurgie hépatique, afin d’établir un état de l’art et préciser les perspectives d’avenir. Suivant les recommandations PRISMA, nous avons identifié les articles publiés en anglais dans PubMed, Embase, et Cochrane Database entre janvier 2000 et janvier 2022 en lien avec les mots clé suivants: réalité augmentée, chirurgie hépatique, foie et hépatectomie. Initialement, 102 titres, études et résumés furent sélectionnés. Vingt-huit articles respectant les critères d’inclusion ont été inclus, rapportant 183 patients opérés avec RA par laparotomie (n = 31) ou laparoscopie (n = 152). Plusieurs technologies d’acquisition et de visualisation étaient rapportées. La précision anatomique était le critère d’évaluation principal utilisé dans 19 articles, avec une valeur comprise entre 3 mm et 14 mm, suivie par la durée d’acquisition et la faisabilité clinique. Plusieurs technologies de RA sont en cours de mise au point mais son utilisation clinique reste limitée, avec des précisions anatomiques encore insuffisantes. Toutefois de nombreuses équipes travaillent à son optimisation et il est probable qu’à court terme l’utilisation de la RA en chirurgie hépatique devienne plus fréquente et plus performante. Son impact pratique, en particulier oncologique, reste à évaluer. During an operation, augmented reality (AR) enables surgeons to enrich their vision of the operating field by means of digital imagery, particularly as regards tumors and anatomical structures. While in some specialties, this type of technology is routinely used, in liver surgery due to the complexity of modeling organ deformities in real time, its applications remain limited. At present, numerous teams are attempting to find a solution applicable to current practice, the objective being to overcome difficulties of intraoperative navigation in an opaque organ. To identify, itemize and analyze series reporting AR techniques tested in liver surgery, the objectives being to establish a state of the art and to provide indications of perspectives for the future. In compliance with the PRISMA guidelines and availing ourselves of the PubMed, Embase and Cochrane databases, we identified English-language articles published between January 2020 and January 2022 corresponding to the following keywords : augmented reality, hepatic surgery, liver and hepatectomy. Initially, 102 titles, studies and summaries were preselected. Twenty-eight corresponding to the inclusion criteria were included, reporting on 183 patients operated with the help of AR by laparotomy (n = 31) or laparoscopy (n = 152). Several techniques of acquisition and visualization were reported. Anatomical precision was the main assessment criterion in 19 articles, with values ranging from 3 mm to 14 mm, followed by time of acquisition and clinical feasibility. While several AR technologies are presently being developed, due to insufficient anatomical precision their clinical applications have remained limited. That much said, numerous teams are currently working toward their optimization, and it is highly likely that in the short term, the application of AR in liver surgery will have become more frequent and effective. As for its clinical impact, notably in oncology, it remains to be assessed.

Introduction: During an operation, augmented reality (AR) enables surgeons to enrich their vision of the operating field by means of digital imagery, particularly as regards tumors and anatomical structures. While in some specialties, this type of technology is routinely ustilized, in liver surgery due to the complexity of modeling organ deformities in real time, its applications remain limited. At present, numerous teams are attempting to find a solution applicable to current practice, the objective being to overcome difficulties of intraoperative navigation in an opaque organ. Objective: To identify, itemize and analyze series reporting AR techniques tested in liver surgery, the objectives being to establish a state of the art and to provide indications of perspectives for the future. Methods: In compliance with the PRISMA guidelines and availing ourselves of the PubMed, Embase and Cochrane databases, we identified English-language articles published between January 2020 and January 2022 corresponding to the following keywords: augmented reality, hepatic surgery, liver and hepatectomy. Results: Initially, 102 titles, studies and summaries were preselected. Twenty-eight corresponding to the inclusion criteria were included, reporting on 183 patients operated with the help of AR by laparotomy (n = 31) or laparoscopy (n = 152). Several techniques of acquisition and visualization were reported. Anatomical precision was the main assessment criterion in 19 articles, with values ranging from 3 mm to 14 mm, followed by time of acquisition and clinical feasibility. Conclusion: While several AR technologies are presently being developed, due to insufficient anatomical precision their clinical applications have remained limited. That much said, numerous teams are currently working toward their optimization, and it is highly likely that in the short term, the application of AR in liver surgery will have become more frequent and effective. As for its clinical impact, notably in oncology, it remains to be assessed. (c) 2023 Elsevier Masson SAS. All rights reserved.

Introduction. - Surgical resection is the current standard of care for retroperitoneal sarcoma (RPS). Recent data suggests that up to 5% of patient have incomplete (R2) resection. The exact reason why patients scheduled for surgery with a curative intent to treat ended up with an R2 resection is largely unknown.Aim of the study. - To identify intraoperative findings responsible for incomplete (R2) resection in primary RPS.Methods. - All records of consecutive patients scheduled for a non-metastatic primary RPS surgery between 1995 and 2020 in a tertiary care sarcoma centre were retrospective analyzed.Results. - Among the 347 patients scheduled for surgery, 13 (3.7%) had an incomplete (R2) resection. The reasons for incomplete surgery were intraoperative finding of vascular involvement of great vessels in 5 patients, previously undetected peritoneal metastases in 5 patients, invasion of contralateral kidney/ureter in 2 patients and the need to preserve both kidneys in 1 patient because of his past medical history. Among these patients, 3 had a laparotomy without resection and 10 had a partial resection (i.e. debulking surgery). Severe postoperative complications occurred in 5 patients. The median length of stay in hospital was 19 days. After a median follow-up of 12 months, the median survival of patients after incomplete resection was 18 months. The 1-y, 5-y and 8-y overall survival (OS) for these patients were 46%, 14%, and 7%, respectively.Conclusion. - Incomplete (R2) resection for a primary RPS surgery is rare in specialized sarcoma center. The next steps should be to identify the preoperative criteria that lead to this accurate selection and to define the best practice in front of a peroperative discovery of an unresectable RPS. Level of evidence.- III.(c) 2023 Published by Elsevier Masson SAS.

The utilization of indocyanine green (ICG) fluorescence imaging in hepatobiliary surgery is a powerful tool for the surgeon to acquire additional information during the intervention. This technology is commonly employed in various specialties and has emerged with a plethora of indications. In this video, we aim to succinctly summarize five main applications of ICG in clinical practice within liver surgery. Firstly, ICG can significantly enhance the diagnostic accuracy of liver tumours by detecting superficial smaller tumours, differentiating benign from malignant tumours and determining the extent of the tumour. This allows for more precise surgical planning and better treatment outcomes. Secondly, ICG can aid in the expansion of hepatectomy by determining the aggressiveness of a tumour, identifying satellite tumours and thus guiding appropriate surgical resection. Thus decreasing the risk of recurrence and improving the patients' overall outcome. Thirdly, ICG can assist in the identification of unusual HCC with infiltrative ICG pattern, and in the detection of intrahepatic metastases, which can be challenging to identify with other imaging methods. Fourthly, ICG can aid in the assessment of liver vascularization at the conclusion of hepatectomy, avoiding post-operative complications such as liver failure. By identifying areas of the liver that are not well perfused, the surgeon can take the necessary measures to avoid such complications and ensure the patient's recovery. Lastly, ICG fluorescence imaging can also be used to check the lymph node during surgery, this provides real-time feedback to the surgeon, which can lead to a more accurate and extensive lymph node dissection, improving the patient's outcome. In conclusion, the utilization of ICG in Liver surgery provides multiple different uses to enhance intraoperative findings, improving the diagnostic accuracy, surgical planning and oncological outcomes, as well as reducing post-operative complications.