PAST
Surgical margin status is the most significant prognostic factor for patients with head and neck cancer.1 Currently, a brief telephone conversation during surgery is the most common method for pathologists to communicate the presence and location of a positive margin. Surgeons rely on the verbal descriptions provided by the pathologist to relocate the margin site and resect additional tissue. Studies have shown that surgeons have difficulty relocating the positive margin site using current protocols with no visual aid due to the complex 3D anatomy of the head and neck. Mean relocation error of a margin is 10.3 mm2 and only 20% of re-resections contain further malignancy.3 In fact, re-resection does not improve patient outcomes.4
PRESENT
In this cadaveric study, we demonstrate the feasibility of a shared augmented reality model to more precisely guide head and neck cancer re-resection.5 After surgical resection, the head and neck specimen was 3D scanned and the virtual 3D specimen model was exported to the Microsoft Holo-Lens augmented reality environment. The surgeon manually aligned the 3D specimen hologram into the resection bed. The mean relocation error was 4 mm, with over 55% of cases having an error less than 2 mm and only 10% of cases with an error of 1 cm. The mean total protocol time, including 3D scanning time and alignment of the 3D specimen hologram within the resection bed, was 25.3 minutes.
FUTURE
Augmented reality surgery using patient-specific 3D specimen models can be broadly applied to other solid malignancies in surgical oncology. Success in future studies will require custom software designed to automatically align the specimen into the defect which will make this work more translatable by improving inter-user reliability, speed, and accuracy. Ultimately, augmented reality surgery will need to be translated into a clinical trial to demonstrate oncologic benefit and value.
FUNDING
This work was supported by a Vanderbilt Clinical Oncology Research Career Development Program—K12 NCI 2K12CA090625–22A1 and an ACS Institutional Research Grant (#IRG-19–139-60) and from the NIH/National Institute for Deafness and Communication Disorders (R25 DC020728).
Footnotes
DISCLOSURE No conflicts of interest to disclose.
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