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Augmented Reality In A Hybrid Or For Pulmonary Nodule Localization And Thoracoscopic Resection – Feasibility Of A Novel Technique

from the APSA 2018 Annual Meeting proceedings

AUGMENTED  REALITY IN A HYBRID OR FOR PULMONARY NODULE LOCALIZATION AND THORACOSCOPIC RESECTION – FEASIBILITY  OF A NOVEL TECHNIQUE

John M. Racadio,  MD, Meera Kotagal, MD, Nicole A. Hilvert, RT(R)(VI), Andrew M. Racadio, BS, Daniel von Allmen, MD.

Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA.

Purpose:  To assess the feasibility of utilizing a novel technique of augmented reality on a hybrid operating  room C-arm system  for image-guided localization and thoracoscopic resection of pulmonary  nodules.

Methods: After obtaining IACUC approval,  silicone pulmonary  nodules were created and subsequently localized in a swine model in our research lab equipped as a hybrid operating room. Four optical cameras embedded in a C-arm system  allowed video co- registration  with a C-arm cone  beam  CT. Skin marker fiducials allowed for optical tracking and motion compensation. An integrated navigation system  enabled optically guided nodule localization without the need  for fluoroscopy,  thus reducing  radiation exposure.

The optical augmented reality navigation was used  to both create and localize nodules. Localization was performed with microcoils. Thoracoscopic resection of the nodules was accomplished using direct visualization and fluoroscopic guidance.

Results: As demonstrated in the video, realistic pulmonary  nodules were created and imaged  using the C-arm cone  beam  CT and an optical/image guidance system  to direct placement. Lesions  were accurately localized using optical/image guidance, enabling placement of microcoils  at the nodules.  Combined  thoracoscopic and fluoroscopic guidance allowed accurate wedge  resection of the nodules.

Conclusions: Injection of silicone creates a realistic pulmonary  nodule  model. Image guidance using emerging  technology combining radiographic and optical imaging is effective in creating  and localizing pulmonary  nodules.  Real-time imaging combined with thoracoscopic visualization facilitates wedge  resection of nodules marked  with microcoils. The hybrid operating  room simplifies the radiographic localization and resection of pulmonary  nodules by eliminating the need  to move the patient from radiology to the operating  room. A collaborative approach combining the skill sets  and technologies of Interventional Radiology and Surgery  offers new opportunities for image guided  surgery.

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