Table 2 Open in new tab Studies included...

Study

Year

Study characteristics

Population number

Simulation technique employed

Main reported outcomes

Abd-El Gawad et al.

2014

NR, NM, NP

Children between the ages of 18 months and 7 years with foreign body aspirations presented.
Virtual bronchoscopy within multidetector CT (MDCT) was used in detecting the tracheobronchial foreign body inhalation.
MDCT findings were compared with results of rigid paediatric bronchoscopy as the gold standard.

MDCT detected the foreign bodies in 17 patients whilst rigid bronchoscopy detected it in 18 patients.
Conventional rigid bronchoscopy had 3 false positives.
MDCT had 1 case of false positive, 1 case of false negative and 2 cases of true positives.
MDCT had a sensitivity of 94.4%, specificity of 75% and accuracy of 90.4%.

Hu et al.

2007

NR, NM, NP

Participants of varying surgical skills predicted the resectability of lung cancers using 3D and 2D images of 6 anonymous patients.
Virtual 3D renderings of the thorax were produced from CT scans and compared with 2D CT images.

3D rendering enhanced the confidence of the prediction by ∼20% as compared to 2D images.
3D rendering increased the accuracy of predicted resectability by ∼20%.
It also decreased the planning time by ∼30%.
It also reduced the workload by ∼50%, in comparison to 2D CT scans.
All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning.

Sato et al.

2017

NR, M, P

500

Patients that required sublobar lung resection or had lesions that were anticipated to be difficult to identify intraoperatively were selected.
Preoperative virtual-assisted lung mapping (VAL-MAP) to intraoperatively localize pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy was used.

Complications occurred in 4 patients (0.8%).
Marks were identifiable during operation in ∼90%.
The successful resection rate was ∼99%. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground-glass nodules (P < 0.0001), tumours <5 mm (P = 0.0016) and performing complex segmentectomy and wedge resection (P = 0.0072).

Sato et al.

2018

NR, M, P

153

Patients that required sublobar lung resection or required careful determination of resection margins were selected.
They underwent preoperative virtual-assisted lung mapping (VAL-MAP) to allow for intraoperative localisation of pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy.

131 wedge resections were performed (71.2%), 51 segmentectomies (27.7%), and 2 other surgical procedures were performed (1.1%).
Successful resection was achieved in 178 lesions (87.8%), and VAL-MAP markings successfully aided in the identification of 190 lesions (93.6%).
Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = 0.0072).

Sekine et al.

2019

NR, NM, P

Preoperative virtual sublobar surgical resection simulations to determine the appropriate tumour resection margin.

The average number of virtual segmentectomies performed was 4.6 ± 1.6. The success rate of transbronchial ICG injections was 89.2% (58/65). The shortest distances to the surgical margin by simulation and by actual measurement were 21.5 ± 11.2 mm and 23.5 ± 8.3 mm (p = 0.190). By propensity score matching, operating time, blood loss, length of hospital stays, and postoperative complications were similar between the ICG injection and control groups.

Shentu et al.

2014

NR, NM, NP

Virtual puncture using radiotherapy planning simulator combined with methylene blue staining for the localization of small peripheral pulmonary lesions.

The average lesion size was 10.4 ± 3.5 mm and the average distance to the pleural surface was 9.4 ± 4.9 mm. The preoperative localization procedure was successful in 75 of 80 (94%) lesions. The shortest distance between the edges of the stain and lesion was 5.1 ± 3.1 mm. Localization time was 17.4 ± 2.3 min. No complications were observed in all participants.

Ueda et al.

2012

NR, NM, NP

3D lung model created using CT scan images for simulation of pulmonary lobectomy and segmentectomy to estimate the probability that a lung cancer arising in a segment has a safety anatomical margin for resection.

For 1-cm virtual tumours, the mean chance to accept segmentectomy was 33 ± 15%, for 2-cm tumours it was 24 ± 13% and for 3-cm tumours it was 18 ± 12%.

Study

Year

Study characteristics

Population number

Simulation technique employed

Main reported outcomes

Abd-El Gawad et al.

2014

NR, NM, NP

Children between the ages of 18 months and 7 years with foreign body aspirations presented.
Virtual bronchoscopy within multidetector CT (MDCT) was used in detecting the tracheobronchial foreign body inhalation.
MDCT findings were compared with results of rigid paediatric bronchoscopy as the gold standard.

MDCT detected the foreign bodies in 17 patients whilst rigid bronchoscopy detected it in 18 patients.
Conventional rigid bronchoscopy had 3 false positives.
MDCT had 1 case of false positive, 1 case of false negative and 2 cases of true positives.
MDCT had a sensitivity of 94.4%, specificity of 75% and accuracy of 90.4%.

Hu et al.

2007

NR, NM, NP

Participants of varying surgical skills predicted the resectability of lung cancers using 3D and 2D images of 6 anonymous patients.
Virtual 3D renderings of the thorax were produced from CT scans and compared with 2D CT images.

3D rendering enhanced the confidence of the prediction by ∼20% as compared to 2D images.
3D rendering increased the accuracy of predicted resectability by ∼20%.
It also decreased the planning time by ∼30%.
It also reduced the workload by ∼50%, in comparison to 2D CT scans.
All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning.

Sato et al.

2017

NR, M, P

500

Patients that required sublobar lung resection or had lesions that were anticipated to be difficult to identify intraoperatively were selected.
Preoperative virtual-assisted lung mapping (VAL-MAP) to intraoperatively localize pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy was used.

Complications occurred in 4 patients (0.8%).
Marks were identifiable during operation in ∼90%.
The successful resection rate was ∼99%. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground-glass nodules (P < 0.0001), tumours <5 mm (P = 0.0016) and performing complex segmentectomy and wedge resection (P = 0.0072).

Sato et al.

2018

NR, M, P

153

Patients that required sublobar lung resection or required careful determination of resection margins were selected.
They underwent preoperative virtual-assisted lung mapping (VAL-MAP) to allow for intraoperative localisation of pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy.

131 wedge resections were performed (71.2%), 51 segmentectomies (27.7%), and 2 other surgical procedures were performed (1.1%).
Successful resection was achieved in 178 lesions (87.8%), and VAL-MAP markings successfully aided in the identification of 190 lesions (93.6%).
Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = 0.0072).

Sekine et al.

2019

NR, NM, P

Preoperative virtual sublobar surgical resection simulations to determine the appropriate tumour resection margin.

The average number of virtual segmentectomies performed was 4.6 ± 1.6. The success rate of transbronchial ICG injections was 89.2% (58/65). The shortest distances to the surgical margin by simulation and by actual measurement were 21.5 ± 11.2 mm and 23.5 ± 8.3 mm (p = 0.190). By propensity score matching, operating time, blood loss, length of hospital stays, and postoperative complications were similar between the ICG injection and control groups.

Shentu et al.

2014

NR, NM, NP

Virtual puncture using radiotherapy planning simulator combined with methylene blue staining for the localization of small peripheral pulmonary lesions.

The average lesion size was 10.4 ± 3.5 mm and the average distance to the pleural surface was 9.4 ± 4.9 mm. The preoperative localization procedure was successful in 75 of 80 (94%) lesions. The shortest distance between the edges of the stain and lesion was 5.1 ± 3.1 mm. Localization time was 17.4 ± 2.3 min. No complications were observed in all participants.

Ueda et al.

2012

NR, NM, NP

3D lung model created using CT scan images for simulation of pulmonary lobectomy and segmentectomy to estimate the probability that a lung cancer arising in a segment has a safety anatomical margin for resection.

For 1-cm virtual tumours, the mean chance to accept segmentectomy was 33 ± 15%, for 2-cm tumours it was 24 ± 13% and for 3-cm tumours it was 18 ± 12%.

Table 2

Open in new tab

Studies included in assessing the preoperative use of VR/AR in thoracic surgery

Study	Year	Study characteristics	Population number	Simulation technique employed	Main reported outcomes
Abd-El Gawad et al.	2014	NR, NM, NP	21	Children between the ages of 18 months and 7 years with foreign body aspirations presented. Virtual bronchoscopy within multidetector CT (MDCT) was used in detecting the tracheobronchial foreign body inhalation. MDCT findings were compared with results of rigid paediatric bronchoscopy as the gold standard.	MDCT detected the foreign bodies in 17 patients whilst rigid bronchoscopy detected it in 18 patients. Conventional rigid bronchoscopy had 3 false positives. MDCT had 1 case of false positive, 1 case of false negative and 2 cases of true positives. MDCT had a sensitivity of 94.4%, specificity of 75% and accuracy of 90.4%.
Hu et al.	2007	NR, NM, NP	17	Participants of varying surgical skills predicted the resectability of lung cancers using 3D and 2D images of 6 anonymous patients. Virtual 3D renderings of the thorax were produced from CT scans and compared with 2D CT images.	3D rendering enhanced the confidence of the prediction by ∼20% as compared to 2D images. 3D rendering increased the accuracy of predicted resectability by ∼20%. It also decreased the planning time by ∼30%. It also reduced the workload by ∼50%, in comparison to 2D CT scans. All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning.
Sato et al.	2017	NR, M, P	500	Patients that required sublobar lung resection or had lesions that were anticipated to be difficult to identify intraoperatively were selected. Preoperative virtual-assisted lung mapping (VAL-MAP) to intraoperatively localize pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy was used.	Complications occurred in 4 patients (0.8%). Marks were identifiable during operation in ∼90%. The successful resection rate was ∼99%. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground-glass nodules (P < 0.0001), tumours <5 mm (P = 0.0016) and performing complex segmentectomy and wedge resection (P = 0.0072).
Sato et al.	2018	NR, M, P	153	Patients that required sublobar lung resection or required careful determination of resection margins were selected. They underwent preoperative virtual-assisted lung mapping (VAL-MAP) to allow for intraoperative localisation of pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy.	131 wedge resections were performed (71.2%), 51 segmentectomies (27.7%), and 2 other surgical procedures were performed (1.1%). Successful resection was achieved in 178 lesions (87.8%), and VAL-MAP markings successfully aided in the identification of 190 lesions (93.6%). Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = 0.0072).
Sekine et al.	2019	NR, NM, P	58	Preoperative virtual sublobar surgical resection simulations to determine the appropriate tumour resection margin.	The average number of virtual segmentectomies performed was 4.6 ± 1.6. The success rate of transbronchial ICG injections was 89.2% (58/65). The shortest distances to the surgical margin by simulation and by actual measurement were 21.5 ± 11.2 mm and 23.5 ± 8.3 mm (p = 0.190). By propensity score matching, operating time, blood loss, length of hospital stays, and postoperative complications were similar between the ICG injection and control groups.
Shentu et al.	2014	NR, NM, NP	74	Virtual puncture using radiotherapy planning simulator combined with methylene blue staining for the localization of small peripheral pulmonary lesions.	The average lesion size was 10.4 ± 3.5 mm and the average distance to the pleural surface was 9.4 ± 4.9 mm. The preoperative localization procedure was successful in 75 of 80 (94%) lesions. The shortest distance between the edges of the stain and lesion was 5.1 ± 3.1 mm. Localization time was 17.4 ± 2.3 min. No complications were observed in all participants.
Ueda et al.	2012	NR, NM, NP	10	3D lung model created using CT scan images for simulation of pulmonary lobectomy and segmentectomy to estimate the probability that a lung cancer arising in a segment has a safety anatomical margin for resection.	For 1-cm virtual tumours, the mean chance to accept segmentectomy was 33 ± 15%, for 2-cm tumours it was 24 ± 13% and for 3-cm tumours it was 18 ± 12%.

Study	Year	Study characteristics	Population number	Simulation technique employed	Main reported outcomes
Abd-El Gawad et al.	2014	NR, NM, NP	21	Children between the ages of 18 months and 7 years with foreign body aspirations presented. Virtual bronchoscopy within multidetector CT (MDCT) was used in detecting the tracheobronchial foreign body inhalation. MDCT findings were compared with results of rigid paediatric bronchoscopy as the gold standard.	MDCT detected the foreign bodies in 17 patients whilst rigid bronchoscopy detected it in 18 patients. Conventional rigid bronchoscopy had 3 false positives. MDCT had 1 case of false positive, 1 case of false negative and 2 cases of true positives. MDCT had a sensitivity of 94.4%, specificity of 75% and accuracy of 90.4%.
Hu et al.	2007	NR, NM, NP	17	Participants of varying surgical skills predicted the resectability of lung cancers using 3D and 2D images of 6 anonymous patients. Virtual 3D renderings of the thorax were produced from CT scans and compared with 2D CT images.	3D rendering enhanced the confidence of the prediction by ∼20% as compared to 2D images. 3D rendering increased the accuracy of predicted resectability by ∼20%. It also decreased the planning time by ∼30%. It also reduced the workload by ∼50%, in comparison to 2D CT scans. All participants preferred viewing 3D displays to reading 2D CT images for preoperative planning.
Sato et al.	2017	NR, M, P	500	Patients that required sublobar lung resection or had lesions that were anticipated to be difficult to identify intraoperatively were selected. Preoperative virtual-assisted lung mapping (VAL-MAP) to intraoperatively localize pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy was used.	Complications occurred in 4 patients (0.8%). Marks were identifiable during operation in ∼90%. The successful resection rate was ∼99%. The contribution of VAL-MAP to surgical success was highly rated by surgeons resecting pure ground-glass nodules (P < 0.0001), tumours <5 mm (P = 0.0016) and performing complex segmentectomy and wedge resection (P = 0.0072).
Sato et al.	2018	NR, M, P	153	Patients that required sublobar lung resection or required careful determination of resection margins were selected. They underwent preoperative virtual-assisted lung mapping (VAL-MAP) to allow for intraoperative localisation of pulmonary lesions using 3D images and bronchoscopic dye injections under regular fluoroscopy.	131 wedge resections were performed (71.2%), 51 segmentectomies (27.7%), and 2 other surgical procedures were performed (1.1%). Successful resection was achieved in 178 lesions (87.8%), and VAL-MAP markings successfully aided in the identification of 190 lesions (93.6%). Multivariable analysis showed that the most significant factor affecting resection success was the depth of the necessary resection margin (P = 0.0072).
Sekine et al.	2019	NR, NM, P	58	Preoperative virtual sublobar surgical resection simulations to determine the appropriate tumour resection margin.	The average number of virtual segmentectomies performed was 4.6 ± 1.6. The success rate of transbronchial ICG injections was 89.2% (58/65). The shortest distances to the surgical margin by simulation and by actual measurement were 21.5 ± 11.2 mm and 23.5 ± 8.3 mm (p = 0.190). By propensity score matching, operating time, blood loss, length of hospital stays, and postoperative complications were similar between the ICG injection and control groups.
Shentu et al.	2014	NR, NM, NP	74	Virtual puncture using radiotherapy planning simulator combined with methylene blue staining for the localization of small peripheral pulmonary lesions.	The average lesion size was 10.4 ± 3.5 mm and the average distance to the pleural surface was 9.4 ± 4.9 mm. The preoperative localization procedure was successful in 75 of 80 (94%) lesions. The shortest distance between the edges of the stain and lesion was 5.1 ± 3.1 mm. Localization time was 17.4 ± 2.3 min. No complications were observed in all participants.
Ueda et al.	2012	NR, NM, NP	10	3D lung model created using CT scan images for simulation of pulmonary lobectomy and segmentectomy to estimate the probability that a lung cancer arising in a segment has a safety anatomical margin for resection.	For 1-cm virtual tumours, the mean chance to accept segmentectomy was 33 ± 15%, for 2-cm tumours it was 24 ± 13% and for 3-cm tumours it was 18 ± 12%.

AR: augmented reality; CT: computed tomography; M: multicentre; NM: non-multicentre; NP: non-prospective; NR: non-randomized; P: prospective; R: randomized; VAL-MAP: virtual-assisted lung mapping; VR: virtual reality.

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