Localisation de nodules pulmonaires en réalité augmentée grâce au Cone Beam Computed Tomography (CBCT) en vidéo-thoracoscopie

Abstract : Objectives: To study the efficiency of CBCT and the use of augmented reality to localize pulmonary nodules in video-assisted thoracic surgery (VATS) Methods: The patients were 18 yo or older. They were suffering from pulmonary lesions, solitary or multiple, whom size were between 5 and 20mm. These lesions were identified pre-operatively thanks to CT. These procedures were performed under general anaesthesia. It was followed by trocar insertion and pneumothorax creation. The CBCT acquisition was performed. The segmentation of the nodule, visualized on the CBCT images, was done. It gave us a 3D reconstruction of the nodule. Then, this 3D image was integrated to fluoroscopic images, in augmented reality, performed during the VATS to localize the nodule. Results: From march 2014 to June 2018, 25 patients have been included in our protocol. Mean age was 63 ± 11 yo. Mean size of the lesion was 13 ± 5 mm and its depth to the pleura was 19 ± 15 mm. The mean density of the lesions was -5 ± 170 HU. Fifteen patients had to undergo a wedge resection, 9 patients a wedge followed by lobectomy and a patient a bi-lobectomy. The mean operative time was 106 ± 42 minutes. We have been able to localize the nodule and do its resection in augmented reality for 24 patients. One nodule has not been detected because of a wrong positioning of the field of view of the CBCT. Mean fluoroscopic time was 124 ± 55 s. Mean time between skin incision and nodule localization was 12 ± 4 minutes. Conclusion: This work differs from the actual localization technic thanks to its strictly intra-operative approach in augmented reality. The CBCT is an efficient tool to localize pulmonary nodules and is of good held in VATS. Associated with augmented reality, this tool offers a significant progress for nodule localization.
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Simon Rouzé, Pablo Alvarez, Bertrand de Latour, Erwan Flécher, Jean-Louis Dillenseger, et al.. Localisation de nodules pulmonaires en réalité augmentée grâce au Cone Beam Computed Tomography (CBCT) en vidéo-thoracoscopie. Bulletin de l'Académie Nationale de Médecine, Elsevier Masson, 2018, 202 (8-9), pp.1897-1908. ⟨10.1016/S0001-4079(19)30183-9⟩. ⟨inserm-02319193⟩

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