中国普通外科杂志2025，Vol.34Issue(11)：2342-2350,9.DOI:10.7659/j.issn.1005-6947.250235
混合现实辅助胸骨后甲状腺肿手术的可行性与安全性分析:附29例报告
Feasibility and safety analysis of mixed reality-assisted surgery for substernal goiter:a report of 29 cases
摘要
Abstract
Background and Aims:Mixed reality(MR)enables real-time visualization of three-dimensional(3D)anatomical models within the operative field,potentially enhancing surgical planning and intraoperative navigation.However,its application in substernal goiter(SSG)surgery has not been reported.This study aimed to evaluate the feasibility,safety,and clinical utility of MR-assisted SSG resection. Methods:A total of 29 patients who underwent MR-assisted surgery for SSG at Lingnan Hospital of the Third Affiliated Hospital of Sun Yat-sen University between May and December 2024 were retrospectively included.The MR workflow consisted of three sequential stages:3D reconstruction,holographic visualization,and device deployment.First,contrast-enhanced cervical CT images were imported into 3D Slicer for semi-automatic three-dimensional reconstruction.The reconstructed models were then processed in Unity3D using the Mixed Reality Toolkit to generate holographic visualizations.Finally,the holographic models were deployed to the HoloLens 2 head-mounted display for perioperative review and manipulation by the surgeon.Clinical characteristics,operative parameters,postoperative complications,and MR usage details were systematically collected and descriptively analyzed. Results:The median thyroid volume was 71.49(49.4-113.52)cm3.Thirteen patients underwent unilateral thyroidectomy,16 underwent bilateral resection,and 8 underwent parathyroid autotransplantation;3 procedures were endoscopic.The median operative time was 145(117.5-161)min,with an estimated blood loss of 10(10-15)mL.Only two patients(6.9%)developed transient hypoparathyroidism,with no permanent complications,recurrent laryngeal nerve injury,postoperative bleeding,or recurrence observed.Reconstruction,holographic processing,and MR application required approximately 60-90 min,15-20 min,and 10-20 min,respectively.Display distortion or latency occurred in six cases,without device-related adverse effects.Most surgeons reported improved anatomical understanding and surgical planning,despite limitations in display brightness and processing capacity. Conclusion:MR-assisted SSG surgery is feasible and safe,offering enhanced spatial perception and operative guidance.It shows promise for improving efficiency and safety in thyroid surgery.Larger prospective studies are warranted to validate its clinical benefits and further optimize the workflow and hardware performance.关键词
甲状腺肿,胸骨后/甲状腺切除术/增强现实/头戴式显示器Key words
Goiter,Substernal/Thyroidectomy/Augmented Reality/Head-Mounted Display分类
医药卫生引用本文复制引用
孙鹏,柯逸凡,张鹏,邬杰忠,黄泽楠,胡昆鹏..混合现实辅助胸骨后甲状腺肿手术的可行性与安全性分析:附29例报告[J].中国普通外科杂志,2025,34(11):2342-2350,9.基金项目
广东省广州市科技计划基金资助项目(2024A03J0986) （2024A03J0986）
广东省基础与应用基础研究基金资助项目(2024A1515220166) （2024A1515220166）
中山大学附属第三医院与潮州市中心医院联合基金资助项目(LH202209). （LH202209）
