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W tym Artykule

  • Overview
  • Protokół
  • Wyniki
  • Materiały
  • Odniesienia

Overview

In this research protocol, we expand upon our previously described three-dimensional (3D) scanning protocol with the addition of augmented reality (AR) technology. Surgical margin status remains one of the most important prognostic features in cancers of the head and neck and is one of the few factors under the control of the head and neck surgeon1,2,3. The complex 3D anatomy of the head and neck often creates difficulty for surgeons attempting to relocate a positive or close margin, and prior studies have demonstrated that accuracy in relocating margins following initial resection is suboptimal4,5,6. As a result, oncologic outcomes following re-resection remain poor2,3. This protocol investigates the feasibility and accuracy of AR to guide the re-resection of initial positive or close margins in head and neck oncologic surgery. This technology allows surgeons to replace a 3D scanned virtual hologram of the resected cancer specimen back into the resection bed to improve visualization of re-resection location to adequately clear an initial positive or close margin. 

ETHICS DISCLAIMER:

This protocol includes the use of cadavers with approval from the Vanderbilt University Medical Center’s Center for Experiential Learning and Assessment. This protocol was performed in compliance with Vanderbilt University Medical Center guidelines for human subjects research under IRB #221733.

Protokół

NOTE: A schematic detailing the protocol workflow can be seen in Figure 1.

1. 3D Scanning

  1. Obtain a 3D Scan of an oncologic resection specimen per the previously described 3D scanning protocol7.
    1. Set up the commercially available, desktop 3D scanner in an area in proximity to the pathology lab where specimens are typically taken.
    2. Gently rinse and pat dry the resected specimen. Take 2D photographs of the anterior and posterior surfaces of the specimen.
    3. Place the specimen on the scanner turntable, ensuring the turntable is protec....

Wyniki

This protocol was established in a cadaveric study7. Twenty cadaveric resections from the head and neck were completed; 13 (65%) cutaneous and 7 (35%) oral cavity resections were performed. The mean value of the greatest diameter of the resected specimens was 4.5 cm (range, 2.5–8.2 cm). The relocation error was (mean ± S.D.) 4 mm ± 3.9 mm (range, 1–15 mm). A significant difference was observed between the mean relocation error of maxillectomy and mandibulectomy specimens and .......

Materiały

NameCompanyCatalog NumberComments
Digital Camera or CameraphoneiPhone May use iPhone or similar camera phone or digital camera.
EinScan SP V2 Platinum Desktop 3D ScannerShining 3D3D scanner hardware
ExScan Software; Solid Edge SHINING 3D EditionShining 3D3D scanner software, included with purchase of 3D Scanner
External MouseMicrosoft
Laptop ComputerDell XP500355-60734-40310-AAOEMLaptop Requirements:
USB: 1 ×USB 2.0 or 3.0; OS: Win 7, 8 or 10 (64 bit);
Graphic Card: Nvidia series; Graphic memory: ＞1G;
CPU: Dual-core i5 or higher; Memory: ＞8G
Microsoft HMD 2Microsoft
Unity SoftwareUnity TechnologiesReal-time, interactive 3D content platform
Microsoft Office SuiteMicrosoft
Mobile Presentation CartOklahoma SoundPRC450
USB-c Device ConverterTRIPP-LITEU442-DOCK3-BNecessary only if laptop does not have USB

Odniesienia

  1. Byers, R. M., Bland, K. I., Borlase, B., Luna, M. The prognostic and therapeutic value of frozen section determinations in the surgical treatment of squamous carcinoma of the head and neck. Am J Surg. 136 (4), 525-528 (1978).
  2. Ettl, T. et al. Positive frozen section margins predict local recurrence in R0-resected squamous cell carcinoma of the head and neck. Oral Oncol. 55, 17-23 (2016).
  3. Szewczyk, M. et al. Positive fresh frozen section margins as an adverse independent prognostic factor for local recurrence in oral cancer patients. Laryngoscope. 128 (5), 1093-1098 (2018).
  4. Ker....

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