Initial Experience with Three-Dimensional Holographic Virtual Bronchoscopy Using Mixed Reality for Peripheral...

Area of Science:

• Pulmonology
• Medical Imaging
• Surgical Technology

Background:

• Accurate diagnosis of peripheral pulmonary lesions is critical in respiratory medicine.
• Advancements like radial endobronchial ultrasound (R-EBUS) and navigation technologies improve distal airway access.
• Mixed reality (MR) provides hands-free visualization of 3D anatomy.

Purpose of the Study:

• To evaluate the technical feasibility and safety of using intraprocedural MR-based holographic virtual bronchoscopy (VB).

Main Methods:

• Retrospective study of 18 patients undergoing bronchoscopy for peripheral pulmonary lesions.
• Utilized an MR-based 3D holographic VB system with HoloLens 2 for real-time anatomical referencing.
• Evaluated procedural variables, R-EBUS findings, biopsy techniques, diagnostic yield, and complications.

Main Results:

• MR-based holographic VB allowed visualization up to the sixth bronchial generation.
• Bronchoscopy reached a median of five generations.
• The overall diagnostic yield was 72.2% (13/18), with malignancy being the most common diagnosis.
• One case of mild pneumothorax occurred, resolving without intervention.

Conclusions:

• MR-based holographic VB is technically feasible and safe for real-time, hands-free 3D anatomical referencing during bronchoscopy.
• Further prospective studies are needed to confirm procedural benefits and integration with other bronchoscopic tools.