PAPS PapersAn augmented reality navigation system for pediatric oncologic surgery based on preoperative CT and MRI images
Introduction
Computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) have increased the amount of anatomical information available to the surgeon. Using real-time navigation based on these imaging modalities, surgeons can easily approach and visualize hidden tumors concealed by organs and detect hidden organs and vessels located under fat tissue [1], [2], [3], [4], [5]. We previously developed a navigation system for use in laparoscopic splenectomy in children that can present real-time anatomical information of the splenic artery and vein, which cannot be otherwise visualized without accurate navigation during surgery [5].
Recently, the use of laparoscopic resection to treat pediatric malignant tumors, such as neuroblastomas, was reported in the literature [6], [7]. However, some surgeries for pediatric oncologic tumors are performed as reoperations after biopsies, chemotherapy and radiotherapy. Therefore, it is sometimes difficult to detect and resect tumors due to adhesion to the surrounding organs caused by previous surgeries and the effects of preoperative chemotherapy and radiotherapy, which decrease the tumor size. Moreover, the difficulty of performing surgery using endoscopic procedures in these cases is increased due to limited views and a lack of tactile sensation. Therefore, we believe that pediatric oncologic surgery is a good indication for surgery using real-time navigation.
We developed an augmented reality (AR) navigation system based on preoperative CT and MRI imaging for endoscopic surgery and laparotomy and herein report our experience with this navigation system in endoscopic surgery and laparotomy for pediatric tumors.
Section snippets
Materials and methods
As reported previously, we have performed navigation surgery for laparoscopic splenectomy in children [5]. Our navigation system provides real-time anatomical information of the pancreas and splenic artery and vein and is very useful and accurate. We employed this navigation system in pediatric surgery for tumors and constructed an AR visualization system that superimposed preoperative MDCT (multi-detector computed tomography) and MRI images onto captured laparoscopic and video camera live
Results
The overlay images of AR navigation obtained during laparoscopic surgery in Case 1 are shown in Fig. 1A. This patient was diagnosed with alveolar rhabdomyosarcoma in the soft plate at 5 years of age. At 6 years of age, a metastatic tumor was recognized in the left chest wall and was resected using thoracoscopy. After surgery, the patient was treated with postoperative chemotherapy and radiotherapy. At 8 years of age, a tiny recurrent mass was detected in the left chest wall on a CT scan.
Discussion
We performed tumor resection using the AR navigation system in children. This system is very useful for performing resection of pediatric tumors because pediatric patients with tumors are sometimes treated with chemotherapy and radiotherapy and have undergone previous surgeries. Adhesion and degenerated tissue caused by previous surgeries, chemotherapy and radiotherapy can disturb future surgeries, especially endoscopic surgery. In this study, the navigation system allowed us to detect and
Conclusion
The AR navigation system is therefore considered to be very useful and good method for detecting the unrecognized tumor location during pediatric surgery, especially for endoscopic surgery.
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