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Bioengineering
Volume 12
Issue 8
10.3390/bioengineering12080896
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Introducing Holographic Surgical Navigation in Pediatric Wilms’ Tumor Patients: A Feasibility Study During Total Nephrectomy

by
Nick T. de Groot
1,
Jasper M. van der Zee
1,
Guus M. J. Bökkerink
1,
Annemieke S. Littooij
1,2,
Caroline C. C. Hulsker
1,
Cecilia E. J. Terwisscha van Scheltinga
1,
Cornelis P. van de Ven
1,
Ruud C. Wortel
3,
Aart J. Klijn
3,
Marc H. W. A. Wijnen
1,
Matthijs Fitski
1 and
Alida F. W. van der Steeg
1,*
1
Department of Pediatric Oncology Surgery, Princess Maxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
2
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, 3584 EA Utrecht, The Netherlands
3
Department of Pediatric Urology, University Medical Center Utrecht/Wilhelmina Children‘s Hospital, 3584 EA Utrecht, The Netherlands
*
Author to whom correspondence should be addressed.
Bioengineering 2025, 12(8), 896; https://doi.org/10.3390/bioengineering12080896 (registering DOI)
Submission received: 17 July 2025 / Revised: 5 August 2025 / Accepted: 15 August 2025 / Published: 21 August 2025
(This article belongs to the Special Issue Augmented Reality, Virtual Reality and Extended Reality Solutions for Biomedical Applications)
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Abstract

Wilms’ tumor is a common pediatric renal malignancy. In selected cases, nephron-sparing surgery (NSS) may be employed as part of the surgical approach. To prevent positive margins, optimal understanding of the tumor–kidney edge is essential. Augmented reality (AR) enables intraoperative visualization of patient-specific three-dimensional (3D) holograms. In this study, we aim to validate the clinical feasibility of a holographic landmark-based registration system in pediatric patients planned for a total nephrectomy (TN), to ensure that the holographic visualization will not influence surgical decision making. In a single-center prospective study, ten pediatric patients undergoing TN were included. Patient-specific 3D holograms were created from preoperative MRI, and intraoperatively landmark-based registration was performed using the HoloLens 2. Clinical feasibility was conducted using accuracy measurements, the System Usability Scale (SUS), and a self-developed questionnaire. Three out of ten patients had a successful registration with a median measured accuracy of 7.0 mm (Interquartile Range (IQR) 6–13.5) and a median SUS score of 75 (IQR 65–77.5). Surgeons reported improved depth perception and anatomical understanding. However, in seven out of ten patients, registration failed due to multiple reasons. The most important factors were large tumor volumes obstructing landmark placement and insufficient spatial distributions of the landmarks, causing rotational misalignment. Although AR showed potential in improving the depth perception and relation in anatomical structures, the landmark-based registration with the HoloLens 2 was currently deemed insufficient for clinical implementation in pediatric abdominal surgery.
Keywords: augmented reality; HoloLens 2; landmark-based registration; nephron-sparing surgery; total nephrectomy; Wilms’ tumor augmented reality; HoloLens 2; landmark-based registration; nephron-sparing surgery; total nephrectomy; Wilms’ tumor
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MDPI and ACS Style

de Groot, N.T.; van der Zee, J.M.; Bökkerink, G.M.J.; Littooij, A.S.; Hulsker, C.C.C.; Terwisscha van Scheltinga, C.E.J.; van de Ven, C.P.; Wortel, R.C.; Klijn, A.J.; Wijnen, M.H.W.A.; et al. Introducing Holographic Surgical Navigation in Pediatric Wilms’ Tumor Patients: A Feasibility Study During Total Nephrectomy. Bioengineering 2025, 12, 896. https://doi.org/10.3390/bioengineering12080896

AMA Style

de Groot NT, van der Zee JM, Bökkerink GMJ, Littooij AS, Hulsker CCC, Terwisscha van Scheltinga CEJ, van de Ven CP, Wortel RC, Klijn AJ, Wijnen MHWA, et al. Introducing Holographic Surgical Navigation in Pediatric Wilms’ Tumor Patients: A Feasibility Study During Total Nephrectomy. Bioengineering. 2025; 12(8):896. https://doi.org/10.3390/bioengineering12080896

Chicago/Turabian Style

de Groot, Nick T., Jasper M. van der Zee, Guus M. J. Bökkerink, Annemieke S. Littooij, Caroline C. C. Hulsker, Cecilia E. J. Terwisscha van Scheltinga, Cornelis P. van de Ven, Ruud C. Wortel, Aart J. Klijn, Marc H. W. A. Wijnen, and et al. 2025. "Introducing Holographic Surgical Navigation in Pediatric Wilms’ Tumor Patients: A Feasibility Study During Total Nephrectomy" Bioengineering 12, no. 8: 896. https://doi.org/10.3390/bioengineering12080896

APA Style

de Groot, N. T., van der Zee, J. M., Bökkerink, G. M. J., Littooij, A. S., Hulsker, C. C. C., Terwisscha van Scheltinga, C. E. J., van de Ven, C. P., Wortel, R. C., Klijn, A. J., Wijnen, M. H. W. A., Fitski, M., & van der Steeg, A. F. W. (2025). Introducing Holographic Surgical Navigation in Pediatric Wilms’ Tumor Patients: A Feasibility Study During Total Nephrectomy. Bioengineering, 12(8), 896. https://doi.org/10.3390/bioengineering12080896

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