ORIGINAL RESEARCH article
Front. Virtual Real.
Sec. Augmented Reality
This article is part of the Research TopicEnabling the Medical Extended Reality ecosystem - Advancements in Technology, Applications and Regulatory ScienceView all 15 articles
Use of Augmented Reality with image fusion to facilitate Surgical Stoma Creation: An IDEAL Stage 2A Case Series
Provisionally accepted
Bradley B Pua1,2*
Shoichiro Urabe1,3*Anupam S Chauhan1,3Alfredo Ormeno Zuniga1
Mauro Dominguez1Davide Punzo1Andras Lasso1Art Sedrakyan1Jeffrey W Milsom1,3*- 1New York Presbyterian Hospital, New York, United States
- 2Weill Cornell Medicine Department of Radiology, New York, United States
- 3Weill Cornell Medicine Department of Surgery, New York, United States
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Introduction: Augmented reality (AR) has been increasingly applied to surgical procedures in fixed anatomical organs like brain, bones, aorta and kidneys, enabling image-guided precision, but sparingly to mobile organs such as the intestines. We report our initial experience with AR-guided intestinal stoma creation using an "image-guided" minimally invasive approach. Methods: Adult patients requiring elective or urgent stoma creation for colonic decompression or diversion were included. Patient-specific 3D reconstructions of the relevant portion of the GI tract and reference organs (skin, bones, vessels) from a preoperative CT were co-registered intraoperatively via a head-mounted AR device (HoloLens2) onto the patient's body using surface landmarks visible such as the umbilicus, bones, and prior surgical scars. A trajectory to the target bowel loop based on AR was marked on the skin, and stoma creation was performed at this site. Targeting of the correct bowel loop was confirmed with intraoperation fluoroscopy using intralumenal contrast injection. Technical success was defined as completion at the targeted site without open surgery. Results: Fourteen patients underwent AR-guided stoma creation (9 colostomies, 5 ileostomies). Indications were bowel obstruction (n=6), fistula (n=5), anastomotic leak (n=1), perforation (n=1) and gastrointestinal bleeding (n=1). Median age was 76 years, median BMI 23.8 kg/m². The median (range) number of prior abdominal surgeries was 2 (0-11). The median operative time was 131 minutes (interquartile range [IQR]: 96–143). The approach was either cut down directly over the stoma site (n=11) or laparoscopic
Keywords: augmented reality, Bowel obstruction, Colostomy, Fistula, Ileostomy, Image guided abdominal intervention
Received: 19 Sep 2025; Accepted: 04 Dec 2025.
Copyright: © 2025 Pua, Urabe, Chauhan, Zuniga, Dominguez, Punzo, Lasso, Sedrakyan and Milsom. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bradley B Pua
Shoichiro Urabe
Jeffrey W Milsom
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