Augmented reality navigation-guided pulmonary nodule localization in a canine model

Chengqiang Li, Yuyan Zheng, Ye Yuan, Hecheng Li, Chengqiang Li, Yuyan Zheng, Ye Yuan, Hecheng Li

Abstract

Background: The current intraoperative pulmonary nodule localization techniques require specific medical equipment or skillful operators, which limits their widespread application. Here, we present an innovative nodule localization technique in a canine lung model using augmented reality (AR) navigation.

Methods: Peripheral pulmonary lesions were artificially created in canine model. A preoperative chest computed tomography scan was performed for each animal. The acquired computed tomography images were analyzed, and an established intraoperative localization plan was uploaded into HoloLens (a head-mounted AR device). Under general anesthesia, lung localization markers were implanted in each canine, guided by the established procedure plan displayed by HoloLens. All artificial lesions and markers were removed by video-assisted wedge resection or lobectomy in a single operation.

Results: Since June 2019, 12 peripheral pulmonary lesions were artificially created in 4 canine models. All lung localization markers were precisely implanted with a median registration and implantation time of 6 minutes (range, 2-15 minutes). The average distance between pulmonary lesions and markers was 1.9±1.7 mm, based on computed tomography examination after localization. No severe pneumothorax was observed after marker implantation. After an average implantation period of 16.5 days, no marker displacement was observed.

Conclusions: The AR navigation-guided pulmonary nodule localization technique was safe and effective in a canine model. The validity and feasibility of using this technology in patients will be examined further (NCT04211051).

Keywords: Augmented reality (AR); animal study; intraoperative nodule localization; navigation.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/tlcr-21-618). The authors have no conflicts of interest to declare.

2021 Translational Lung Cancer Research. All rights reserved.

Figures

Figure 1
Figure 1
Lungbrella marker device set. The device set includes the following three major components. (A) Puncture needle with 3D-trackable QR code-like pattern; (B) nitinol braided marker; (C) putter. The marker is pre-loaded inside the puncture needle and extruded by the putter after the needle has reached the desired release location. QR code, quick response code.
Figure 2
Figure 2
Skin marker. The skin marker consists of a transparent skin dressing and CT-visible copper markers, with holes in their centers, covered with strength paper to facilitate the taping procedure. The distance between two consecutive copper markers is 2 cm. CT, computed tomography.
Figure 3
Figure 3
Positioning QR code. A board with a printed QR code, together with green head/feet direction indication letters (in Chinese). This board will be placed beside the operating area before navigation start. QR code, quick response code.
Figure 4
Figure 4
HoloLens navigation-guided puncture. The operator (Author Chengqiang Li) inserting the second needle into the animal’s lung under HoloLens guidance. The animal was under general anesthesia in the supine position.
Video 1
Video 1
Procedure of augmented reality navigation-guided pulmonary nodule localization.
Figure 5
Figure 5
Post-marker implantation procedures (marker ID 12). After each marker implantation, a CT scan was performed to verify its immediate distance from the artificial lesion. After three markers were implanted, the VATS procedure was executed to evaluate each marker’s anchoring status within the lung tissue. All three implanted markers were resected by wedge resection or lobectomy procedures to determine the actual relative positions of the marker and the artificial lesion. (A) Reconstructed CT image showing the artificial lesion and the implanted marker; (B) pulling the tail of the marker during the VATS operation; (C) sliced tissue sample after wedge resection. CT, computed tomography; VATS, video-assisted thoracoscopic surgery.
Figure 6
Figure 6
Estimated workflow of the AR navigation-guided nodule localization. AR, augmented reality; CT, computed tomography.

References

    1. Bolton WD, Howe H, 3rd, Stephenson JE. The utility of electromagnetic navigational bronchoscopy as a localization tool for robotic resection of small pulmonary nodules. Ann Thorac Surg 2014;98:471-5; discussion 475-6. 10.1016/j.athoracsur.2014.04.085
    1. Gill RR, Zheng Y, Barlow JS, et al. Image-guided video assisted thoracoscopic surgery (iVATS) - phase I-II clinical trial. J Surg Oncol 2015;112:18-25. 10.1002/jso.23941
    1. Gill RR, Barlow J, Jaklitsch MT, et al. Image-guided video-assisted thoracoscopic resection (iVATS): Translation to clinical practice-real-world experience. J Surg Oncol 2020;121:1225-32. 10.1002/jso.25897
    1. Chen PH, Hsu HH, Yang SM, et al. Preoperative Dye Localization for Thoracoscopic Lung Surgery: Hybrid Versus Computed Tomography Room. Ann Thorac Surg 2018;106:1661-7. 10.1016/j.athoracsur.2018.07.030
    1. Chao YK, Pan KT, Wen CT, et al. A comparison of efficacy and safety of preoperative versus intraoperative computed tomography-guided thoracoscopic lung resection. J Thorac Cardiovasc Surg 2018;156:1974-83.e1. 10.1016/j.jtcvs.2018.06.088
    1. Zhang L, Wang L, Kadeer X, et al. Accuracy of a 3-Dimensionally Printed Navigational Template for Localizing Small Pulmonary Nodules: A Noninferiority Randomized Clinical Trial. JAMA Surg 2019;154:295-303. 10.1001/jamasurg.2018.4872
    1. Keating J, Singhal S. Novel Methods of Intraoperative Localization and Margin Assessment of Pulmonary Nodules. Semin Thorac Cardiovasc Surg 2016;28:127-36. 10.1053/j.semtcvs.2016.01.006
    1. Predina JD, Newton A, Corbett C, et al. Localization of Pulmonary Ground-Glass Opacities with Folate Receptor-Targeted Intraoperative Molecular Imaging. J Thorac Oncol 2018;13:1028-36. 10.1016/j.jtho.2018.03.023
    1. Vávra P, Roman J, Zonča P, et al. Recent Development of Augmented Reality in Surgery: A Review. J Healthc Eng 2017;2017:4574172. 10.1155/2017/4574172
    1. Molina CA, Theodore N, Ahmed AK, et al. Augmented reality-assisted pedicle screw insertion: a cadaveric proof-of-concept study. J Neurosurg Spine 2019. [Epub ahead of print]. doi: .10.3171/2018.12.SPINE181142
    1. Fitzpatrick JM, West JB, Maurer CR, Jr. Predicting error in rigid-body point-based registration. IEEE Trans Med Imaging 1998;17:694-702. 10.1109/42.736021
    1. Schwarz Y, Mehta AC, Ernst A, et al. Electromagnetic navigation during flexible bronchoscopy. Respiration 2003;70:516-22. 10.1159/000074210
    1. Anayama T, Qiu J, Chan H, et al. Localization of pulmonary nodules using navigation bronchoscope and a near-infrared fluorescence thoracoscope. Ann Thorac Surg 2015;99:224-30. 10.1016/j.athoracsur.2014.07.050
    1. Kondo R, Yoshida K, Hamanaka K, et al. Intraoperative ultrasonographic localization of pulmonary ground-glass opacities. J Thorac Cardiovasc Surg 2009;138:837-42. 10.1016/j.jtcvs.2009.02.002
    1. Pan J, Liu W, Ge P, et al. Real-time segmentation and tracking of excised corneal contour by deep neural networks for DALK surgical navigation. Comput Methods Programs Biomed 2020;197:105679. 10.1016/j.cmpb.2020.105679
    1. Luo H, Yin D, Zhang S, et al. Augmented reality navigation for liver resection with a stereoscopic laparoscope. Comput Methods Programs Biomed 2020;187:105099. 10.1016/j.cmpb.2019.105099
    1. Dennler C, Jaberg L, Spirig J, et al. Augmented reality-based navigation increases precision of pedicle screw insertion. J Orthop Surg Res 2020;15:174. 10.1186/s13018-020-01690-x
    1. Park CH, Han K, Hur J, et al. Comparative Effectiveness and Safety of Preoperative Lung Localization for Pulmonary Nodules: A Systematic Review and Meta-analysis. Chest 2017;151:316-28. 10.1016/j.chest.2016.09.017
    1. Chao YK, Wen CT, Fang HY, et al. A single-center experience of 100 image-guided video-assisted thoracoscopic surgery procedures. J Thorac Dis 2018;10:S1624-30. 10.21037/jtd.2018.04.44

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する