Electromagnetic Surgical Navigation for Accurate Pediatric Tumor Localization: A Preclinical Animal Cadaver Study

Background: Localization of non-palpable, non-visible, and difficult location tumors in children can be surgically complex. Incomplete resections upstage the tumor, leading to a significant reduction in survival and the intensification of adjuvant treatment, affecting quality of life. Surgical navigation set-ups showed promising results in adults but have not yet been validated in complex pediatric oncology surgery. In this study, an in-house developed electromagnetic surgical navigation set-up was evaluated in a pre-clinical cadaver study. Methods: Pediatric oncology surgeons (n = 8) performed navigated tumor resection in eight simulated surgeries. Embalmed piglets with tumors simulated through insertion underwent preoperative CT imaging for 3D modeling. Navigation was initialized with an ultrasound-based registration procedure. During the procedures, the surgeons had to localize and remove the simulated tumors using the navigation set-up, and the ease of use was evaluated by the system usability score (SUS). The registration and localization accuracies were calculated with the surface and target registration errors, respectively. Results: The registration was successful in 7/8 experiments. The median surface and target registration errors were <2 mm and <3 mm, respectively. The surgeons scored above average acceptance of the navigation set-up with a median SUS of 72 (IQR: 62-80). Conclusions: The navigation set-up was successful overall, with surgeons being satisfied concerning the usability and accuracy of the technique. This study supports progression toward clinical evaluation.