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.
Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada.
Ann Thorac Surg. 2018 Nov;106(5):1468-1475. doi: 10.1016/j.athoracsur.2018.06.062. Epub 2018 Aug 16.
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.
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.
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).
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.
我们开发了一种带有实时增强图像引导的胸腔镜手术导航系统，以评估其在微创切除胸壁肿瘤方面的潜在益处。我们在胸壁肿瘤模型中评估了肿瘤和切缘定位的准确性，以及对任务工作量和信心的影响。
通过锥形束 CT 扫描并将数据注册到系统中后，对真实的肿瘤模型进行扫描，以显示三维轮廓的肿瘤和切缘。然后我们让 15 名外科医生仅使用胸腔镜定位肿瘤边缘和手术切缘。然后在激活手术导航系统的情况下进行相同的操作，并比较每次尝试的结果。之后，我们完成了问卷调查和美国国家航空航天局任务负荷指数评估。
手术导航系统显著降低了内侧（p = 0.002）和上侧肿瘤边缘（p < 0.001）的定位误差，这些部位仅用胸腔镜难以观察。所有的手术切缘都得到了改善，包括用胸腔镜容易看到的切缘。美国国家航空航天局任务负荷指数评分显示，所有子量表的工作量都有统计学显著降低。在绩效（10.1 对 4.4，p = 0.001）和挫折感（13.0 对 5.4，p = 0.001）方面，工作量平均减少了 50%以上。
这项研究表明，胸腔镜手术导航系统提供的增强图像引导减少了胸腔镜难以观察到的区域的肿瘤定位误差，并且无论胸腔镜的可视性如何，都减少了手术切缘的误差。该系统还降低了工作量，增加了外科医生定位具有挑战性的胸壁肿瘤的信心。
