Electromagnetic Surgical Navigation for Accurate Pediatric Tumor Localization: A Preclinical Animal Cadaver Study.

Background

Localization of non-palpable, non-visible, and difficult location tumors in children can be surgically complex. Incomplete resections upstage the tumor, leading to a significant reduction in survival and the intensification of adjuvant treatment, affecting quality of life. Surgical navigation set-ups showed promising results in adults but have not yet been validated in complex pediatric oncology surgery. In this study, an in-house developed electromagnetic surgical navigation set-up was evaluated in a pre-clinical cadaver study.

Methods

Pediatric oncology surgeons (n = 8) performed navigated tumor resection in eight simulated surgeries. Embalmed piglets with tumors simulated through insertion underwent preoperative CT imaging for 3D modeling. Navigation was initialized with an ultrasound-based registration procedure. During the procedures, the surgeons had to localize and remove the simulated tumors using the navigation set-up, and the ease of use was evaluated by the system usability score (SUS). The registration and localization accuracies were calculated with the surface and target registration errors, respectively.

Results

The registration was successful in 7/8 experiments. The median surface and target registration errors were <2 mm and <3 mm, respectively. The surgeons scored above average acceptance of the navigation set-up with a median SUS of 72 (IQR: 62-80).

Conclusions

The navigation set-up was successful overall, with surgeons being satisfied concerning the usability and accuracy of the technique. This study supports progression toward clinical evaluation.