Electromagnetic Surgical Navigation for Accurate Pediatric Tumor Localization: A Preclinical Animal Cadaver Study
Cancers, vol. 18, pp. 2831
Abstract
Background: Localization of non-palpable, non-visible, and difficult location tumors in children can be surgically complex. Incomplete resections upstage the tumor, leading to a significant reduction in survival and the intensification of adjuvant treatment, affecting quality of life. Surgical navigation set-ups showed promising results in adults but have not yet been validated in complex pediatric oncology surgery. In this study, an in-house developed electromagnetic surgical navigation set-up was evaluated in a pre-clinical cadaver study. Methods: Pediatric oncology surgeons (n = 8) performed navigated tumor resection in eight simulated surgeries. Embalmed piglets with tumors simulated through insertion underwent preoperative CT imaging for 3D modeling. Navigation was initialized with an ultrasound-based registration procedure. During the procedures, the surgeons had to localize and remove the simulated tumors using the navigation set-up, and the ease of use was evaluated by the system usability score (SUS). The registration and localization accuracies were calculated with the surface and target registration errors, respectively. Results: The registration was successful in 7/8 experiments. The median surface and target registration errors were <2 mm and <3 mm, respectively. The surgeons scored above average acceptance of the navigation set-up with a median SUS of 72 (IQR: 62–80). Conclusions: The navigation set-up was successful overall, with surgeons being satisfied concerning the usability and accuracy of the technique. This study supports progression toward clinical evaluation.
Authors 11
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Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Princess Máxima Center · University of Twente
Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
Technical Medicine, University of Twente, 7522 NB Enschede, The Netherlands
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Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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Leiden University Medical Center · Princess Máxima Center
Affiliation as printed
Department of Orthopedics, Leiden University Medical Center, 2333 ZG Leiden, The Netherlands
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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Affiliation as printed
Department of Clinical Sciences, Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
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Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Surgical Oncology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
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Alida F. W. van der Steeg corresponding
Affiliation as printed
Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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