An augmented reality navigation system for pediatric oncologic surgery based on preoperative CT and MRI images

• Published in: Journal of pediatric surgery 2013-12, Vol.48 (12), p.2479-2483
• Main Authors: Souzaki, Ryota, Ieiri, Satoshi, Uemura, Munenori, Ohuchida, Kenoki, Tomikawa, Morimasa, Kinoshita, Yoshiaki, Koga, Yuhki, Suminoe, Aiko, Kohashi, Kenichi, Oda, Yoshinao, Hara, Toshiro, Hashizume, Makoto, Taguchi, Tomoaki
• Format: Article
• Language: English
• Subjects: Augmented reality; Bronchogenic Cyst - diagnostic imaging; Bronchogenic Cyst - surgery; Child; Child, Preschool; Hepatoblastoma - diagnostic imaging; Hepatoblastoma - surgery; Humans; Image Processing, Computer-Assisted; Image-guided surgery; Imaging, Three-Dimensional; Infant; Laparoscopic surgery; Laparoscopy - methods; Laparotomy - methods; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Magnetic Resonance Imaging; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - surgery; Neoplasms - diagnostic imaging; Neoplasms - surgery; Pediatrics; Preoperative Care; Rhabdomyosarcoma - diagnostic imaging; Rhabdomyosarcoma - secondary; Rhabdomyosarcoma - surgery; Sarcoma - diagnostic imaging; Sarcoma - surgery; Surgery; Surgery, Computer-Assisted - methods; Thoracoscopy - methods; Tomography, X-Ray Computed; Treatment Outcome; Wilms Tumor - diagnostic imaging; Wilms Tumor - surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.08.025

Abstract Purpose In pediatric endoscopic surgery, a limited view and lack of tactile sensation restrict the surgeon's abilities. Moreover, in pediatric oncology, it is sometimes difficult to detect and resect tumors due to the adhesion and degeneration of tumors treated with multimodality therapies. We developed an augmented reality (AR) navigation system based on preoperative CT and MRI imaging for use in endoscopic surgery for pediatric tumors. Methods The patients preoperatively underwent either CT or MRI with body surface markers. We used an optical tracking system to register the reconstructed 3D images obtained from the CT and MRI data and body surface markers during surgery. AR visualization was superimposed with the 3D images projected onto captured live images. Six patients underwent surgery using this system. Results The median age of the patients was 3.5 years. Two of the six patients underwent laparoscopic surgery, two patients underwent thoracoscopic surgery, and two patients underwent laparotomy using this system. The indications for surgery were local recurrence of a Wilms tumor in one case, metastasis of rhabdomyosarcoma in one case, undifferentiated sarcoma in one case, bronchogenic cysts in two cases, and hepatoblastoma in one case. The average tumor size was 22.0 ± 14.2 mm. Four patients were treated with chemotherapy, three patients were treated with radiotherapy before surgery, and four patients underwent reoperation. All six tumors were detected using the AR navigation system and successfully resected without any complications. Conclusions The AR navigation system is very useful for detecting the tumor location during pediatric surgery, especially for endoscopic surgery.