Clinical Application of an Ergonomic Holographic Device to Optimize Port Placement in Robotic Mitral Valve Surgery: Proof-of-Concept Study

Robotic assistance in mitral valve surgery is being increasingly adopted; however, standardized port placement does not yet account for patient-specific anatomy. Augmented reality (AR) can provide real-time, holographic views of anatomy based on preoperative imaging, yet its application in robotic cardiac surgery is unreported. We tested the clinical use of the HoloLens 2 device to create dynamic hologram overlays on patients during robotic-assisted mitral valve surgery to optimize robotic port placement. Using a three-dimensional (3D) slicer and Unity software, a pipeline generated patient-specific 3D holographic models from preoperative computed tomography scans. An experienced robotic cardiac surgical team tested the prototype in October 2024 at Gavazzeni Hospital (Bergamo, Italy). Feedback highlighted its comfort, confidence enhancement, and user-friendliness. This proof-of-concept study demonstrates the feasibility and user-friendliness of an ergonomic, AR-based holographic device to optimize port placement in robotic mitral valve surgery.