ROLE OF THE HOLO-LENS IN INTRA-OPERATIVE LOCALIZATION OF THE PARATHYROID ADENOMA USING 3D RECONSTRUCTED MODELS OF THE NECK.

AUTHORS:
A. Ahmed (London, United Kingdom) , S. Chegini (London, United Kingdom) , M. Mahar (Alexandria, Egypt) , Z. Haq (London, United Kingdom) , T. Abdel-Aziz (London, United Kingdom)
Background:
Surgery is the main treatment of primary hyperparathyroidism(PHPT). Minimal invasive parathyroidectomy(MIP) requires the incision just over the parathyroid adenoma(PA). The HoloLens opens up a new era of mixed reality . In this study we used the HoloLens to superimpose a virtual 3D model of the parathyroid adenoma onto the patient's neck.
Methods:
The study included 27 PHPT patients planned to have MIP. The PA was localized with both Ultrasound and CT parathyroid. A 3D virtual model based on CT parathyroid was created for 13 patients using "3Dslicer5.6.0" comprising group A with 14 patients with no model in group B. Models were uploaded to "Microsoft Holo-lens 2" and used for localisation of the PA intra-operatively using an anatomical bony landmark triangulation technique.
Results:
There were 19 female (70.3%) and 8 male patients (29.6%). Age ranged from 30 to 81 years. The PA was in the right upper position in 10 patients (37%). Operative time in group A ranged from (45-137 minutes) with median 54 minutes while in group B ranged from (49-140 minutes) with median 70 minutes. In group A 12 patients had MIP and one patient converted to open parathyroidectomy. The accuracy of Holo-lens in precisely locating the PA was 92.3%. In group B, 11 patients had MIP and 3 patients were converted to OP(27%).
Conclusions:
Holo-lens improves intra-operative localization of PA in MIP and reduces the conversion rate of MIP as well as reducing the operative time. It will be of a value in improving training program.