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D’Agostino J, Wall J, Soler L, Vix M, Duh Q, Marescaux J. Virtual Neck Exploration for Parathyroid Adenomas: A First Step Toward Minimally Invasive Image-Guided Surgery. JAMA Surg. 2013;148(3):232–238. doi:10.1001/jamasurg.2013.739
Authors Affiliations: IRCAD/Institut
Hospitalo Universitaire, Strasbourg, France (Drs D’Agostino,
Wall, Soler, Vix, and Marescaux); University of California, and VA
Medical Center, San Francisco, California (Dr Duh).
Objective To evaluate the performance of 3-dimensional (3D) virtual neck
exploration (VNE) as a modality for preoperative localization of parathyroid
adenomas in primary hyperparathyroidism and assess the feasibility
of using augmented reality to guide parathyroidectomy as a step toward
minimally invasive image-guided surgery.
Design Enhanced 3D rendering methods can be used to transform computed
tomographic scan images into a model for 3D VNE. In addition to a
standard imaging modality, 3D VNE was performed in all patients and
used to preoperatively plan minimally invasive parathyroidectomy.
All preoperative localization studies were analyzed for their sensitivity,
specificity, positive predictive value, and negative predictive value
for the correct side of the adenoma(s) (lateralization) and the correct
quadrant of the neck (localization). The 3D VNE model was used to
generate intraoperative augmented reality in 3 cases.
Setting Tertiary care center.
Patients A total of 114 consecutive patients with primary hyperparathyroidism
were included from January 8, 2008, through July 26, 2011.
Results The accuracy of 3D VNE in lateralization and localization was
77.2% and 64.9%, respectively. Virtual neck exploration had superior
sensitivity to ultrasonography (P < .001),
sestamibi scanning (P = .07), and
standard computed tomography (P < .001).
Use of the 3D model for intraoperative augmented reality was feasible.
Conclusions 3-Dimensional VNE is an excellent tool in preoperative localization
of parathyroid adenomas with sensitivity, specificity, and diagnostic
accuracy commensurate with accepted first-line imaging modalities.
The added value of 3D VNE includes enhanced preoperative planning
and intraoperative augmented reality to enable less-invasive image-guided
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