Chang Young Lee1, Harley Chan2, Hideki Ujiie3, Kosuke Fujino3, Tomonari Kinoshita3, Jonathan C Irish4, Kazuhiro Yasufuku5. 1. Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea. 2. Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada. 3. Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada. 4. Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada. 5. Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: kazuhiro.yasufuku@uhn.ca.
Abstract
BACKGROUND: We developed a thoracoscopic surgical navigation system with real-time augmented image guidance to assess the potential benefits for minimally invasive resection of chest wall tumors. The accuracy of localization of tumor and resection margin and the effect on task workload and confidence were evaluated in a chest wall tumor phantom. METHODS: After scanning a realistic tumor phantom by cone-beam computed tomography and registering the data into the system, three-dimensional contoured tumor and resection margin was displayed. Fifteen surgeons were asked to localize the tumor margin and surgical margins with the thoracoscope alone. The same procedure was performed with the surgical navigation system activated, and results were compared between each attempt. A questionnaire and National Aeronautics and Space Administration Task Load Index were completed after. RESULTS: The surgical navigation system significantly reduced localization error for the medial (p = 0.002) and superior tumor margin (p < 0.001), which was difficult to visualize by thoracoscopy alone. All surgical resection margins were improved circumferentially, including margins that were readily visible by thoracoscopy. National Aeronautics and Space Administration Task Load Index response scores showed a statistically significant reduction in workload in all subscales. There was a more than 50% mean reduction in workload for performance (10.1 vs 4.4, p = 0.001) and frustration (13.0 vs 5.4, p = 0.001). CONCLUSIONS: This study showed that the thoracoscopic surgical navigation system providing augmented image guidance decreased tumor localization error for regions difficult to visualize thoracoscopically and also reduced surgical margin error circumferentially, regardless of thoracoscopic visibility. This system also reduced workload and increased surgeon's confidence in localizing challenging chest wall tumors.
BACKGROUND: We developed a thoracoscopic surgical navigation system with real-time augmented image guidance to assess the potential benefits for minimally invasive resection of chest wall tumors. The accuracy of localization of tumor and resection margin and the effect on task workload and confidence were evaluated in a chest wall tumor phantom. METHODS: After scanning a realistic tumor phantom by cone-beam computed tomography and registering the data into the system, three-dimensional contoured tumor and resection margin was displayed. Fifteen surgeons were asked to localize the tumor margin and surgical margins with the thoracoscope alone. The same procedure was performed with the surgical navigation system activated, and results were compared between each attempt. A questionnaire and National Aeronautics and Space Administration Task Load Index were completed after. RESULTS: The surgical navigation system significantly reduced localization error for the medial (p = 0.002) and superior tumor margin (p < 0.001), which was difficult to visualize by thoracoscopy alone. All surgical resection margins were improved circumferentially, including margins that were readily visible by thoracoscopy. National Aeronautics and Space Administration Task Load Index response scores showed a statistically significant reduction in workload in all subscales. There was a more than 50% mean reduction in workload for performance (10.1 vs 4.4, p = 0.001) and frustration (13.0 vs 5.4, p = 0.001). CONCLUSIONS: This study showed that the thoracoscopic surgical navigation system providing augmented image guidance decreased tumor localization error for regions difficult to visualize thoracoscopically and also reduced surgical margin error circumferentially, regardless of thoracoscopic visibility. This system also reduced workload and increased surgeon's confidence in localizing challenging chest wall tumors.
Authors: Axel Sahovaler; Harley H L Chan; Tommaso Gualtieri; Michael Daly; Marco Ferrari; Claire Vannelli; Donovan Eu; Mirko Manojlovic-Kolarski; Susannah Orzell; Stefano Taboni; John R de Almeida; David P Goldstein; Alberto Deganello; Piero Nicolai; Ralph W Gilbert; Jonathan C Irish Journal: Front Oncol Date: 2021-11-01 Impact factor: 6.244