Virtual Neck Exploration for Parathyroid Adenomas

Abstract

Objective: To evaluate the performance of 3-dimensional (3D) virtual neck exploration (VNE) as a modality for preoperative localization of parathyroid adenomas in primary hyperparathyroidism and assess the feasibility of using augmented reality to guide parathyroidectomy as a step toward minimally invasive imageguided surgery.Design: Enhanced 3D rendering methods can be used to transform computed tomographic scan images into a model for 3D VNE. In addition to a standard imaging modality, 3D VNE was performed in all patients and used to preoperatively plan minimally invasive parathyroidectomy. All preoperative localization studies were analyzed for their sensitivity, specificity, positive predictive value, and negative predictive value for the correct side of the adenoma(s) (lateralization) and the correct quadrant of the neck (localization). The 3D VNE model was used to generate intraoperative augmented reality in 3 cases. Setting: Tertiary care center.Patients: A total of 114 consecutive patients with primary hyperparathyroidism were included from January 8, 2008, through July 26, 2011.Results: The accuracy of 3D VNE in lateralization and localization was 77.2% and 64.9%, respectively. Virtual neck exploration had superior sensitivity to ultrasonography (PϽ.001), sestamibi scanning (P=.07), and standard computed tomography (PϽ.001). Use of the 3D model for intraoperative augmented reality was feasible.Conclusions: 3-Dimensional VNE is an excellent tool in preoperative localization of parathyroid adenomas with sensitivity, specificity, and diagnostic accuracy commensurate with accepted first-line imaging modalities. The added value of 3D VNE includes enhanced preoperative planning and intraoperative augmented reality to enable less-invasive image-guided surgery.

18F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism

“…This is a non-interventional, monocentric, retrospective study involving patients with pHPT and negative/discordant parathyroid scintigraphy and neck US, who were assessed at the University of Strasbourg Hospital between May 2018 and October 2019 using integrated 18 F-FCH PET/4D-CT for identification of hyperfunctioning parathyroid glands and preoperative three-dimensional (3D) virtual neck explorations [ 20 , 21 ]. Patients with clinical and biological data missing at the time of PET/4D-CT and with a clinical and biological follow-up less than 6 months after surgery or PET/4D-CT investigation were excluded.…”

Recent Development of Augmented Reality in Surgery: A Review

“…AR has also been successfully employed during splenectomies in children [ 33 ] and urological procedures [ 86 ]. With the increasing precision of AR systems, they can be safely used even in endocrine surgeries [ 87 – 89 ], otorhinolaryngologic surgery [ 90 ], eye surgery [ 91 ], vascular surgery [ 92 , 93 ], or dental implantology too [ 60 ]; however, their exact usefulness in such surgeries is not exactly quantified owing to the complicated structures [ 61 ]. An AR system for transcatheter aortic valve implantation was designed and successfully used by Currie et al, showing comparable accuracy to traditional fluoroscopic guidance technique, hence avoiding impending complications of contrast agent administration [ 93 ].…”

Applications of Augmented Reality in Otolaryngology: A Systematic Review

“…Eyewear was used by 4 platforms. Two platforms used projectors 17 ; 1, microscope eyepieces 32 ; 2, dedicated monitors 24,27 ; 1, the Da Vinci surgeon console 25 ; and 1, a handheld camera. 19…”

“…Another limitation of a unified view is the increased risk for inattentional blindness, which is a phenomenon in which “objects go unnoticed despite being clearly within one’s field of view because of concentration on an alternative object or task.” 24 Previous studies suggested that AR may increase inattentional blindness. 24 While dedicated monitors may decrease inattention, 24,27 this removes the benefits of a unified view. Future studies are warranted to determine whether a unified surgical field or the avoidance of inattentional blindness should be prioritized for the best surgical outcomes.…”

“…24 Previous studies suggested that AR may increase inattentional blindness. 24 While dedicated monitors may decrease inattention, 24,27 this removes the benefits of a unified view. Future studies are warranted to determine whether a unified surgical field or the avoidance of inattentional blindness should be prioritized for the best surgical outcomes.…”