Clinical Application and Further Development of Augmented Reality Guidance for the Surgical Localization of Pediatric Chest Wall Tumors

• Published in: Journal of pediatric surgery 2024-08, Vol.59 (8), p.1549-1555
• Main Authors: van der Woude, Rémi, Fitski, Matthijs, van der Zee, Jasper M., van de Ven, Cornelis P., Bökkerink, Guus M.J., Wijnen, Marc H.W.A., Meulstee, Jene W., van Doormaal, Tristan P.C., Siepel, Françoise J., van der Steeg, Alida F.W.
• Format: Article
• Language: English
• Subjects: Augmented reality; Chest wall resections; Point-based registration; Surface matching; Tumor localization
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2024.02.023

Surgical treatment of pediatric chest wall tumors requires accurate surgical planning and tumor localization to achieve radical resections while sparing as much healthy tissue as possible. Augmented Reality (AR) could facilitate surgical decision making by improving anatomical understanding and intraoperative tumor localization. We present our clinical experience with the use of an AR system for intraoperative tumor localization during chest wall resections. Furthermore, we present the pre-clinical results of a new registration method to improve our conventional AR system. From January 2021, we used the HoloLens 2 for pre-incisional tumor localization during all chest wall resections inside our center. A patient-specific 3D model was projected onto the patient by use of a five-point registration method based on anatomical landmarks. Furthermore, we developed and pre-clinically tested a surface matching method to allow post-incisional AR guidance by performing registration on the exposed surface of the ribs. Successful registration and holographic overlay were achieved in eight patients. The projection seemed most accurate when landmarks were positioned in a non-symmetric configuration in proximity to the tumor. Disagreements between the overlay and expected tumor location were mainly due to user-dependent registration errors. The pre-clinical tests of the surface matching method proved the feasibility of registration on the exposed ribs. Our results prove the applicability of AR guidance for the pre- and post-incisional localization of pediatric chest wall tumors during surgery. The system has the potential to enable intraoperative 3D visualization, hereby facilitating surgical planning and management of chest wall resections. IV Treatment Study •What is currently known about this topic? Augmented Reality is a visualization technique that can give a direct impression of the patient's anatomy in 3D and therefore has great potential within surgical applications.•What new information is contained in this article? This article presents the clinical application and further development of an AR system for intraoperative tumor localization during pediatric chest wall resections.