Case Report: Application of HoloLens for Intra-Operative Assessment of a Retrosternal Thyroid Goitre

Abstract

Thyroidectomy is a common surgical procedure performed to treat a myriad of thyroid pathologies. 2-19% of thyroidectomies involve a retrosternal goitre, which is an extension of thyroid tissue into the thoracic cavity. Resection of retrosternal goitres are more challenging that standard thyroidectomies and typically have higher complication rate of recurrent laryngeal nerve injury, hypoparathyroidism and post op bleeding. Goitres can be removed either via a transcervical approach, transthoracic approach or a combination of both. A transcervical approach is generally favoured. Direct visualisation of the lower poles of the goitre is challenging in such scenarios, making it difficult to confirm full removal of the goitre. Retrosternal goitres are usually evaluated and characterised with cross-sectional imaging such as a computed tomography (CT) scan, in order to estimate the size and location of the goitre. We demonstrate a mixed reality technique of visualising retrosternal goitres, involving projecting three-dimensional (3D) reconstruction of the CT scan onto the patient to directly visualise the size and location of the goitre. This guides surgeons in the removal of retrosternal goitres, with the aim to reduce complications and facilitate complete excision of the goitre. We believe that HoloLens2 is a novel new adjunct which will aid surgeons in future surgeries involving a retrosternal goitre.