Augmented Reality to Guide Lymph-Node Resection in Gynecologic Malignancies: A Pilot Study

Objectives: Identifying and resecting gynecologic lymph-node metastases can be challenging. Augmented reality (AR) may improve localization of such lesions and adjacent structures.Materials and Methods: For this prospective case series of women who had lymphadenectomy for gynecologic malignancies at a tertiary-care center, a 3-dimensional targeted lesions model was created. It was based on preoperative axial imaging (computed tomography [CT] or positron emission tomography [PET]) of the lesions, which were evaluated by the surgical team preoperatively. The surgeon wore an AR wireless headset, enabling real-time use of the model to assist lymph-node resection.Results: This pilot study included 7 patients: 4 had lymphadenectomy with hysterectomy and bilateral salpingo-oophorectomy; 2 had lymphadenectomy; and 1 had lymphadenectomy during pelvic exenteration. Median age was 53 (34-70) and mean body mass index was 28.3 (+/- 6.5). Mean operating room time was 223 (+/- 130.9) minutes, mean blood loss was 398.5 (+/- 600.1) mL, and 1 patient needed a blood transfusion. Overall, there were no significant differences between the preoperative assessments of the sizes and locations of the lesions with AR, compared to axial imaging. Surgeons' evaluations of the model revealed that 7 (50%) indicated that the AR model was superior to axial imaging; 4 (28.6%) noted that the AR model prompted them to change their surgical approaches. AR modeling changed the surgical approaches in 2 cases and improved surgical accuracy, disease characteristics, or intra- and postoperative outcomes.Conclusions: Preoperative evaluation with AR was meaningful, compared to conventional methods in 25%-50% of cases. The effect of AR should be investigated further in a larger study. (J GYNECOL SURG 39:289)