Novel Intraoperative Augmented Reality-Guided Specimen Localization in Chest Wall Oncologic Surgery: A Case Report

Localization and communication of surgical margins remain a challenge in oncologic surgery, particularly in the setting of staged reconstruction where wound bed deformation alters native anatomical landmarks. This proof-of-concept case report evaluates the feasibility of augmented reality (AR) to reorient a specimen-derived 3D tumor model within the resection bed during staged chest wall reconstruction. One patient with a recurrent undifferentiated pleomorphic sarcoma of the chest wall underwent radical chest wall excision with staged reconstruction. Following resection, the specimen was scanned with a structured-light 3D scanner to create a digital twin. The 3D model was virtually annotated to mirror the standard grossing process using a custom computer-aided design software. The mapped model was uploaded into an Apple Vision Pro (AVP) AR headset. On the day of the staged reconstruction, the holographic specimen model was reoriented in situ using predefined anatomical landmarks for registration during the surgical setup period. First-time AR users were able to manipulate and correctly position the model after a brief onboarding. AR-guided placement was completed without altering routine care or delaying operative workflow (surgeon onboarding to AVP: 5 min; AR specimen placement and verification: 5 min). Alignment was qualitatively confirmed with inked specimen surfaces and resected rib orientation in the wound bed. No positive margin was identified in this index case, therefore performance for margin relocalization was not assessed. In this single-case study, AR-guided reorientation of a specimen-derived 3D model in reconstructive chest wall surgery was feasible and compatible with surgical workflows.