Novel, noninvasive, extended reality-aided pulmonary tumor marking method for sublobar resection in minimally invasive surgery.

Objective: We developed a novel, noninvasive, extended reality-aided marking procedure for tumor localization and aimed to evaluate its feasibility and safety for sublobar resection in minimally invasive surgery. Methods: We prospectively evaluated the concordance rate between extended reality-aided marking and actual tumor localization for 20 patients who underwent sublobar resection, including wedge resection and segmentectomy. During sublobar resection, the augmented reality image of the 3-dimensional pulmonary anatomy and the tumor were overlaid onto the thoracoscopic monitor. This allowed the surgeons to observe the tumor location with the head-mounted mixed reality display during the surgery. Marking concordance was defined as the difference of 10 mm or less between the distances from the actual tumor margin and the identified marking point on the extended reality to the margin. Results: We enrolled 11 patients who underwent wedge resection and 9 patients who underwent segmentectomy. For each case, the pulmonary anatomy and tumor were successfully overlaid onto the operative image. The median computed tomography tumor size was 13.5 mm (interquartile range, 10.7-21.7 mm). The extended reality-aided marking method accurately delineated 90% of cases (18 of 20). The median distance from the actual surgical margin was 18 mm (interquartile range, 11-23.5 mm). The median duration of surgery was 117 (interquartile range, 64-147) minutes, and the perioperative courses were uneventful for all cases except for paroxysmal atrial fibrillation in 1 patient. Conclusions: Our novel, noninvasive, extended reality-based marking method is safe and feasible for identifying tumor locations during sublobar resection.