Abstract Body:

Background: Near-infrared (NIR) imaging systems in surgery, typically reliant on monitors, may distract surgeons and increase the risk of errors. This study develops augmented reality eyewear display (AR-EWD) that display real-time NIR images to aid surgery by visualizing target areas and evaluate clinical feasibility through preclinical and clinical studies.

Methods: AR-EWD generates stereoscopic images by combining NIR fluorescence and visible light from the target site. These images, processed by an algorithm developed on the Visual Studio 2017 C++ platform, are relayed directly to the surgeon through AR optics. The system’s efficiency was tested using indocyanine green (ICG)-based NIR images in various animal models. Additionally, specimens from 10 lung tumor patients labeled with ICG preoperatively were examined and compared to images from standard NIR fluorescence imaging systems.

Results: AR-EWD system featured a 60° field of view, full high definition resolution, a video refresh rate of 30 fps, and a high modulation transfer function of 30 cyc/mm. AR-EWD accurately imaged sentinel lymph nodes, intersegmental planes, and lung tumor in rabbit models, with image fidelity consistent with real observations. It also successfully detected lung pseudotumor and intersegmental planes in canine models, aiding in segmentectomies. In the clinical study, the AR-EWD detected lung tumor in all 10 patients, aligning closely with standard NIR fluorescence imaging systems.

Conclusions: The AR-EWD proved effective in providing clear, real-time images of the target area, thereby enabling highly immersive surgical procedures. Therefore, AR-EWD can be fully integrated into oncological surgery, enhancing the surgeon’s capabilities.

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