Three-Dimensional Deformations of Pulmonary Collapse for Intraoperative Augmented Reality Guidance: A Proof-of-Concept Study

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery, vol. 21, pp. 37–47

Abstract

OBJECTIVE: During pulmonary surgery, the lung is deflated to facilitate the procedure. This study aimed to assess the deformation of the bronchial tree and pulmonary parenchyma during lung collapse, for eventual use in augmented reality (AR) guidance during pulmonary resections. METHODS: The concept was first tested in 2 porcine models by analyzing paired computed tomography scans of collapsed and inflated lungs, then applied to 6 human patients. Bronchus and parenchyma were segmented, and a bronchus centerline was calculated. The diameter, length differences, angular deformations, and volume differences of the parenchyma were calculated. Finally, these deformations were applied on the inflated bronchus centerline to generate an artificially collapsed bronchus. RESULTS: = 0.79). Median volume reduction was 970 mL for the right lung and 878 mL for the left lung. Bronchial narrowing was observed, with a median diameter reduction of 0.14 mm for the right lung and 1.23 mm for the left lung. Moreover, the lengths of the bronchial segments were reduced, with a median length reduction of 0.20 mm for the right sided and 0.72 mm for the left sided. CONCLUSIONS: Algorithmically driven calculations of the intraoperative pulmonary collapse of human and porcine lungs were performed and applied onto an inspirated bronchus. This resulted in an artificial collapsed bronchus. This method could be a foundation for a dynamical deformable deflation model, suitable for intraoperative AR-based pulmonary navigation.

Authors 8

1. Jette J. Peek

   Erasmus MC

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

2. Tjerko Kieft
   Affiliation as printed

   Surgical Reality, Nieuw-Vennep, The Netherlands

3. Rahi S. Alipour Symakani

   Erasmus MC

   Affiliation as printed

   Department of Cardiology, Division of Experimental Cardiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands

   Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

   Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands

4. Amir H. Sadeghi

   Erasmus MC · University Medical Center Utrecht

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

   Department of Cardiothoracic Surgery, University Medical Center Utrecht, The Netherlands

5. Mathieu M. E. Wijffels

   Erasmus MC

   Affiliation as printed

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

6. Esther M.M. Van Lieshout

   Erasmus MC

   Affiliation as printed

   Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

7. Ad J.J.C. Bogers

   Erasmus MC

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

8. Edris A.F. Mahtab corresponding Aachen Department of Cardiothoracic Surgery

   Leiden University Medical Center · Erasmus MC

   Affiliation as printed

   Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands

   Department of Cardiothoracic Surgery, Leiden University Medical Center, The Netherlands