Miyahara Naofumi, Hiratsuka Masafumi, Okamoto Yusuke, Teishikata Takashi, Kamohara Keiji
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, Saga, 849-0937, Japan.
Department of General Thoracic, Breast, and Paediatric Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-Ku, Fukuoka, Fukuoka, 814-0180, Japan.
Surg Endosc. 2025 Mar;39(3):2164-2170. doi: 10.1007/s00464-025-11593-9. Epub 2025 Feb 11.
Accurate lymph node (LN) dissection is crucial in the surgical management of lung cancer. However, studies addressing the challenges of anatomically precise LN dissection are limited. This study aimed to evaluate the utility and safety of mixed reality (MR) holograms as an intraoperative support tool for hilar and mediastinal lymph node dissection (HMLND).
Polygonal (stereolithographic) files of the thoracic cavity were created from SYNAPSE VINCENT images and uploaded into Holoeyes MD virtual reality software. The three-dimensional (3D) holograms generated from these images were displayed on head-mounted displays (HoloLens2) worn by the surgeons and their assistants during HMLND. Intraoperative hologram support (IHS) safety was assessed in 10 patients who underwent HMLND with anatomical lung resection. Additionally, the utility of the intraoperative hologram was evaluated through a questionnaire completed by four thoracic surgeons experienced in hologram manipulation.
IHS was used for a median duration of 5 min (interquartile range: 4-6). No 90-day postoperative complications were observed. Surgeons unanimously agreed that the holograms accurately represented the vascular and bronchial structures of the hilar and mediastinal regions. Additionally, none of the surgeons disagreed that the holograms provided greater benefit intraoperatively compared to preoperatively. In particular, IHS was found effective for the dissection of non-adjacent interlobar LNs post-segmentectomy and LN #4L.
IHS improved the surgical understanding of thoracic anatomy during HMLND, potentially leading to more precise and reliable LN dissection.
准确的淋巴结清扫在肺癌的外科治疗中至关重要。然而，针对解剖学精确淋巴结清扫挑战的研究有限。本研究旨在评估混合现实（MR）全息图作为肺门和纵隔淋巴结清扫术（HMLND）术中支持工具的实用性和安全性。
从SYNAPSE VINCENT图像创建胸腔的多边形（立体光刻）文件，并上传到Holoeyes MD虚拟现实软件中。在HMLND期间，由这些图像生成的三维（3D）全息图显示在外科医生及其助手佩戴的头戴式显示器（HoloLens2）上。对10例行解剖性肺切除的HMLND患者评估术中全息图支持（IHS）的安全性。此外，通过由四位有全息图操作经验的胸外科医生填写的问卷来评估术中全息图的实用性。
IHS的使用中位持续时间为5分钟（四分位间距：4 - 6分钟）。未观察到90天术后并发症。外科医生一致认为全息图准确呈现了肺门和纵隔区域的血管和支气管结构。此外，没有外科医生不同意全息图在术中比术前提供了更大的益处。特别是，发现IHS对段切除术后非相邻叶间淋巴结和第4L组淋巴结的清扫有效。
IHS提高了HMLND期间外科医生对胸部解剖结构的理解，可能导致更精确和可靠的淋巴结清扫。
