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

Rémi van der Woude; Matthijs Fitski; Jasper M van der Zee; Cornelis P van de Ven; Guus M J Bökkerink; Marc H W A Wijnen; Jene W Meulstee; Tristan P C van Doormaal; Françoise J Siepel; Alida F W van der Steeg

doi:10.1016/j.jpedsurg.2024.02.023

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

J Pediatr Surg. 2024 Feb 24:S0022-3468(24)00105-2. doi: 10.1016/j.jpedsurg.2024.02.023. Online ahead of print.

Affiliations

¹ Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands; Technical Medicine, TechMed Centre, University of Twente, Drienderlolaan 5, 7522 NB, Enschede, the Netherlands.
² Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
³ Augmedit B.V., Naarden, the Netherlands.
⁴ Augmedit B.V., Naarden, the Netherlands; Department of Neurosurgery, Brain Division, University Medical Center, Utrecht, the Netherlands.
⁵ Robotics and Mechatronics, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands.
⁶ Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands. Electronic address: A.F.W.vanderSteeg@prinsesmaximacentrum.nl.

PMID: 38472040
DOI: 10.1016/j.jpedsurg.2024.02.023

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Level of evidence: IV TYPE OF STUDY: Treatment Study.

Keywords: Augmented reality; Chest wall resections; Point-based registration; Surface matching; Tumor localization.