We invite you to read the February article in the ’12 o’clock on the 12th’ series.
The Institute of Mother and Child initiated the Mother and Child Startup Challenge (MCSC) competition, aimed at utilizing modern medical technologies to protect the health and lives of patients. The first edition of the competition, organized in 2022, was won by the CarnaLife Holo system – an innovative solution created by the Polish company MedApp S.A. The main prize was the opportunity to test the device in clinical conditions. CarnaLife Holo allows doctors three-dimensional visualization of organs and tumors. This makes precise operation planning easier, and the procedure itself – more precise. The system uses imaging data from computed tomography (CT) and magnetic resonance imaging (MRI), transforming them into three-dimensional models of pathological changes. These, in turn, are integrated with holograms in the CarnaLife Holo application, giving surgeons a completely new perspective during surgery.
But does this modern technology actually translate into tangible benefits for doctors and patients? The answers to this question were provided by pioneering studies conducted at the Institute of Mother and Child in Warsaw.
Technology versus cancer – how innovations are changing oncological surgery
Contemporary oncological surgery faces many challenges, especially in the case of the youngest patients, where precision and minimal invasiveness of surgical procedures are crucial. One of the most modern tools supporting surgeons in these complex operations is mixed reality (MR) technology, which allows for spatial mapping of anatomical structures in the form of interactive holograms and interaction with the displayed hologram.
Thanks to HoloLens 2 goggles from Microsoft, the doctor can see a three-dimensional hologram reflecting the structure of the imaged anatomical area in real space. Moreover, the doctor can interact with the displayed hologram – rotate it, enlarge it, move it, or even enter inside anatomical structures. Everything is done using gestures and voice commands, without the need to touch equipment and the risk of losing sterility. The goggles serve as an auxiliary, interactive screen that supports operation planning and remains accessible anywhere in the operating room. The hologram can even be superimposed directly onto the patient’s body, allowing surgeons to better understand the anatomical relationships of the operated structures and facilitating the procedure.
How did mixed reality reach the operating room? Testing MR at the Institute of Mother and Child
In accordance with the MCSC competition conditions, in 2023-2024, we tested the winning solution from MedApp at the Clinic of Oncology and Oncological Surgery for Children and Youth of the Institute of Mother and Child.
The first procedure using MedApp technology was performed in February 2023 on a patient with foot sarcoma, who was suspected of having metastatic changes in the soft tissues of the thigh. In subsequent cases, innovative imaging supported us, among others, during surgery on a 3-year-old patient with a soft tissue tumor in the sacrococcygeal region, on a patient with metastases of osteosarcoma of the femur to the lungs, and during the complex removal of a tumor at the sternal end of the clavicle, which was compressing key anatomical structures of the neck.
Does MR revolutionize oncological surgery?
To fully answer the question of how modern technology affects doctors’ work, a retrospective study was conducted, analyzing data from patients undergoing surgical operations at the Clinic of Oncology and Oncological Surgery for Children and Youth. Cases using MR were compared with procedures performed in the standard way. The study included nine patients with various types of cancerous changes, including:
- lung metastases,
- sacrococcygeal region tumor,
- clavicle tumor,
- thoracic wall tumor
- soft tissue tumors
- bone tumors.
The research team focused on two indicators of treatment effectiveness: the duration of the procedure and the length of hospitalization. The analysis showed that the use of mixed reality MR technology did not have a significant impact on these parameters – procedures did not take longer, and patients did not have to stay in the hospital longer.
However, it is worth considering the learning curve of the surgical team, which became increasingly proficient in using MR technology with each subsequent operation. Initially, doctors had to spend time learning to operate the system, but with each procedure, interaction with the software became more intuitive and fluid, which could further improve work comfort and operational efficiency.
In future studies, these two indicators can serve as an objective measure of the CarnaLife Holo system’s effectiveness. The results of our team’s work were presented at the SIOP congress in Honolulu (17-20.10. 2024), the EURO EWING Consortium 21st Network Meeting (21. 01. 2025), and during the St. Jude Global EURO Meeting training (22. 01. 2025), where they met with great interest from the medical community.
A new perspective on operations – what do doctors and patients gain?
The CarnaLife Holo system is not only modern technology but also real support for surgical teams. Analysis showed that MR technology does not prolong operations or patients’ hospital stays, confirming its safety and effectiveness. Additionally, its use brings a number of additional benefits that can significantly support the work of surgical teams:
- better visualization of anatomical structures – doctors can accurately view the tumor and its position before and during the operation. Detailed visualization helps determine the best method of access to diseased structures and plan and perform the operation;
- reduced risk of complications – better preparation for the operation and its smooth execution can limit the risk of damage to healthy tissues;
- new educational possibilities – holographic models allow doctors, residents, and students to better understand complex cases.
What’s more, MR can help not only doctors but also patients and their families. The ability to see a three-dimensional anatomical model helps parents and children better understand the entire treatment process. This, in turn, helps reduce fear of the unknown, build trust in the medical team, and increase patients’ psychological comfort.
From innovation to daily practice – the future of mixed reality in service of patient well-being
Studies using the CarnaLife Holo system show that MR technology is a promising tool supporting oncological surgery, however, its full impact on the course of operations requires further analysis. Conducting broader studies on larger and more homogeneous patient groups and developing objective criteria for assessing the usefulness of this technology will be crucial.
As technology advances and the number of studies on its application grows, MR may become standard in surgery, increasing the precision of procedures and improving treatment outcomes for the youngest patients. The fact that its use does not prolong operation time or hospitalization, while bringing numerous benefits to surgeons and patients, may favor its widespread implementation. As experience accumulates and tools improve, it will become possible to shorten operation times and accelerate patients’ recovery. Let’s also not forget the positive assessments of this technology by surgeons participating in the operations conducted.
Mixed reality technology not only revolutionizes the diagnosis and treatment of children, especially those with cancerous diseases, but also constitutes a powerful educational tool for doctors. Thanks to this, we can acquire knowledge in a more interactive way and improve the ability to analyze anatomical structures during the planning and execution of surgical procedures, which undoubtedly raises the standards of medical care. We eagerly await further challenges and opportunities that will allow us to better assess the potential of this groundbreaking technology.
Author
Krzysztof Bronowicki, MD, PhD – specialist in pediatric surgery and oncological surgery. In 2007, he defended his doctoral thesis at the Institute of Mother and Child in Warsaw. He worked in the Pediatric Surgery Department of the Lower Silesian Specialist Hospital named after Tadeusz Marciniak – Emergency Medicine Center in Wrocław and at Mouwasat Hospital in Dammam, Saudi Arabia. Senior assistant at the Clinic of Oncology and Oncological Surgery for Children and Youth at the Institute of Mother and Child in Warsaw. He completed specialist training and research internships at Polish and foreign centers in the Netherlands and Germany. He is the co-author of numerous scientific papers presented at national and international congresses and works published in Polish and foreign medical literature. Member of the Polish Society of Pediatric Surgeons (PTChD), the Polish Society of Pediatric Hematology and Oncology (PTOHD), the Polish Society of Surgical Oncology (PTChO), the International Society of Pediatric Surgical Oncology (IPSO- SIOP), the EURO EWING Consortium (EEC) Surgery Working Group, Renal Tumour Study Group – SIOP.
See also:
12 o’clock on the 12th: January – Tomasz Maciejewski, MD, PhD Medical innovations in Poland: development directions and future challenges