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Augmented reality-guided localization of a chest wall tumor in a pediatric patient

      Pediatric surgical treatment of chest wall tumors presents unique complexities. Resecting one or multiple ribs can lead to significant chest wall deformities, potentially inflicting restrictions on respiration and mobilization [
      • Zöllner S.K.
      • Amatruda J.F.
      • Bauer S.
      • Collaud S.
      • de Álava E.
      • DuBois S.G.
      • et al.
      Ewing sarcoma—diagnosis, treatment, clinical challenges and future perspectives.
      ,
      • Lopez C.
      • Correa A.
      • Vaporciyan A.
      • Austin M.
      • Rice D.
      • Hayes-Jordan A.
      Outcomes of chest wall resections in pediatric sarcoma patients.
      ]. Complete tumor resection achieving adequate surgical margins whilst sparing as much healthy tissue as possible can only be accomplished through meticulous surgical planning. Conventional surgical planning is based on 2D imaging. Therefore, the 3D relation and perception greatly depend on the surgeons' spatial interpretation [
      • Hegarty M.
      • Keehner M.
      • Cohen C.
      • Montello D.R.
      • Lippa Y.
      The role of spatial cognition in medicine: applications for selecting and training professionals.
      ]. Tumor localization based on external landmarks can be difficult. This is especially true for small lesions that are invisible, non-palpable, or lesions, which have significantly responded to neo-adjuvant chemotherapy [
      • Incarbone M.
      • Pastorino U.
      Surgical treatment of chest wall tumors.
      ]. Therefore, additional procedures may be required for precise target localization intraoperatively. Providing the surgeon with intraoperative 3D guidance could overcome these challenges and significantly improve surgical planning and patient-specific anatomical understanding. 3D guidance using AR has improved several aspects within different surgical disciplines [
      • Pérez-Pachón L.
      • Poyade M.
      • Lowe T.
      • Gröning F.
      Image overlay surgery based on augmented reality: a systematic review.
      ,
      • Gibby J.T.
      • Swenson S.A.
      • Cvetko S.
      • Rao R.
      • Javan R.
      Head-mounted display augmented reality to guide pedicle screw placement utilizing computed tomography.
      ,
      • Vávra P.
      • Roman J.
      • Zonca P.
      • Ihnát P.
      • Nemec M.
      • Kumar J.
      • et al.
      Recent development of augmented reality in surgery: a review.
      ,
      • Yoon J.W.
      • Chen R.E.
      • Kim E.J.
      • Akinduro O.O.
      • Kerezoudis P.
      • Han P.K.
      • et al.
      Augmented reality for the surgeon: systematic review.
      ,
      • Kim Y.
      • Kim H.
      • Kim Y.O.
      Virtual reality and augmented reality in plastic surgery: a review.
      ,
      • Jiang T.
      • Zhu M.
      • Zan T.
      • Gu B.
      • Li Q.
      A novel augmented reality-based navigation system in perforator flap transplantation - a feasibility study.
      ]. However, in pediatric surgical oncology, the intraoperative use of AR has not yet been described. We introduce a holographic AR system to visualize and localize chest wall tumors in a pediatric patient.
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