Mixed Reality Assisted Radical Endoscopic Thyroidectomy

Summary

Radical endoscopic thyroidectomy is associated with various surgical complications. This study utilizes mixed reality techniques to assist surgeons in performing radical endoscopic thyroidectomy, aiming to enhance its safety and lower the surgical threshold.

Abstract

Radical endoscopic thyroidectomy (ET) offers superior cosmetic outcomes and enhanced visibility of the surgical field compared to open surgery. However, the thyroid's unique physiological functions and intricate surrounding anatomy may result in various surgical complications. Mixed reality (MR), a real-time holographic visualization technology, enables the creation of highly realistic 3D models in the real world and facilitates multiple human-computer interactions. MR can be utilized for both preoperative evaluation and intraoperative navigation. First, semi-automatic 3D reconstruction of the neck from enhanced computed tomography images is performed using 3Dslicer. Next, the 3D model is imported into Unity3D to create a virtual hologram that can be displayed on an MR helmet-mounted display (HMD). During surgery, surgeons can wear the MR HMD to locate lesions and surrounding anatomy through the virtual hologram. In this study, patients requiring radical ET were randomly assigned to either the experimental group or the control group. Surgeons performed MR-assisted radical ET in the experimental group. A comparative analysis of surgical outcomes and the results of scales was conducted. This study successfully developed the neck 3D model and the virtual hologram. According to the NASA Task Load Index Scale, the experimental group exhibited significantly higher scores in 'Own Performance' and lower scores in 'Effort' compared to the control group (p = 0.002). Additionally, on the Likert Subjective Evaluation Scale, the mean scores for all questions exceeded 3. Although the incidence of surgical complications was lower in the experimental group than in the control group, the differences in surgical outcomes were not statistically significant.MR is beneficial for enhancing performance and alleviating the burden of surgeons during the perioperative period. Furthermore, MR has demonstrated the potential to enhance the safety of ET. Therefore, it is essential to further investigate the surgical applications of MR.

Introduction

Over the past decade, the global incidence of thyroid nodules has risen to 29.29%, reflecting an increase of 7.76% compared to the previous decade. This trend positions thyroid nodules as one of the most prevalent diseases¹. Concurrently, the incidence of thyroid cancer has reached 20/100,000, ranking it seventh among all cancers and third among females. Radical surgery remains the preferred treatment approach².

Thyroidectomy can be categorized into open, endoscopic, and robotic surgeries. Endoscopic thyroidectomy (ET) is a form of cosmetic surgery that employs the length of endoscopic instrum....

Protocol

The protocol follows the guidelines of the human research ethics committee of Sun Yat-Sen University. No specific ethics approval is required since this treatment was performed in routine clinical care.

1. 3D reconstruction

1. Import DICOM data from neck-enhanced CT scans into 3DSlicer¹⁰, utilizing a window width of 350 Hounsfield units (HU) and a window level of 40 HU.
2. Segment and reconstruct the neck 3D model using a semi-automatic .......

Discussion

MR is a cutting-edge AI technology based on various algorithmic models and sensing devices. The purpose of this protocol is to utilize MR to assist in radical ET. Moreover, the key procedure is the construction of the neck 3D model and virtual hologram. Subjective scales indicate positive results, demonstrating that MR is benefitial for surgeons in performing radical ET with ease. Additionally, MR exhibits potential advantages in preventing complications associated with ET. However, the small sample size limits the signi.......

Materials

Name	Company	Catalog Number	Comments
3DSlicer	Slicer		https://www.slicer.org/
HoloLens2	Microsoft		a type of mixed reality helmet mounted display https://www.microsoft.com/en-us/hololens/hardware#document-experiences