title: An augmented reality navigation system for pediatric oncologic surgery based on preoperative CT and MRI images.
abstract: OBJECTIVE
  In pediatric endoscopic surgery, a limited view and lack of tactile sensation restrict the surgeon's abilities. Moreover, in pediatric oncology, it is sometimes difficult to detect and resect tumors due to the adhesion and degeneration of tumors treated with multimodality therapies. We developed an augmented reality (AR) navigation system based on preoperative CT and MRI imaging for use in endoscopic surgery for pediatric tumors.
  
  
  METHODS
  The patients preoperatively underwent either CT or MRI with body surface markers. We used an optical tracking system to register the reconstructed 3D images obtained from the CT and MRI data and body surface markers during surgery. AR visualization was superimposed with the 3D images projected onto captured live images. Six patients underwent surgery using this system.
  
  
  RESULTS
  The median age of the patients was 3.5 years. Two of the six patients underwent laparoscopic surgery, two patients underwent thoracoscopic surgery, and two patients underwent laparotomy using this system. The indications for surgery were local recurrence of a Wilms tumor in one case, metastasis of rhabdomyosarcoma in one case, undifferentiated sarcoma in one case, bronchogenic cysts in two cases, and hepatoblastoma in one case. The average tumor size was 22.0±14.2 mm. Four patients were treated with chemotherapy, three patients were treated with radiotherapy before surgery, and four patients underwent reoperation. All six tumors were detected using the AR navigation system and successfully resected without any complications.
  
  
  CONCLUSIONS
  The AR navigation system is very useful for detecting the tumor location during pediatric surgery, especially for endoscopic surgery.
authors: Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Advance Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan. Electronic address: ryotas@pedsurg.med.kyushu-u.ac.jp.
authors: Ryota
authors: R
authors: Souzaki
authors: Satoshi
authors: S
authors: Ieiri
authors: Munenori
authors: M
authors: Uemura
authors: Kenoki
authors: K
authors: Ohuchida
authors: Morimasa
authors: M
authors: Tomikawa
authors: Yoshiaki
authors: Y
authors: Kinoshita
authors: Yuhki
authors: Y
authors: Koga
authors: Aiko
authors: A
authors: Suminoe
authors: Kenichi
authors: K
authors: Kohashi
authors: Yoshinao
authors: Y
authors: Oda
authors: Toshiro
authors: T
authors: Hara
authors: Makoto
authors: M
authors: Hashizume
authors: Tomoaki
authors: T
authors: Taguchi
mesh_terms: D001994:Bronchogenic Cyst / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018197:Hepatoblastoma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000601:surgery; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011300:Preoperative Care; D012208:Rhabdomyosarcoma / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Augmented reality; Image-guided surgery; Laparoscopic surgery