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Augmented Reality For Intraoperative Lymphatic Localization Using Ct-derived 3d Overlays: A Feasibility Study With Meta Quest 3
Yazan Mahafza, MD, William Albabish, M.Sc., PhD., Erica Tedone Clemente, MD, Ryan Klatte, B.S. BME, Wei F. Chen, MD, FACS.
Cleveland Clinic Foundation, Cleveland, OH, USA.
PURPOSE: Precise localization and visualization of inguinal lymph nodes is critical in lymphatic surgery (lymph node-to-vein anastomosis (LNVA)). While (newer) techniques such as 3D-printed anatomical models have improved surgical planning by offering tangible representations of patient anatomy, they are time-consuming to produce and add significant cost. Augmented reality (AR) offers a rapid, cost-effective alternative for intraoperative visualization of patient-specific structures.
METHODS: Using patient CT scans, we generated 3D reconstructions of lymphatic anatomy in the femoral and inguinal regions. These models were overlaid directly onto the patient using the Meta Quest 3 AR headset. Fiduciary skin markers were applied during imaging to enable manual alignment of the CT-derived models to the patient’s body. We evaluated the accuracy of AR overlays, surgeon usability, and intraoperative integration across six OR cases.
RESULTS: The AR overlays demonstrated high anatomical fidelity, with accuracy constrained primarily by CT resolution and segmentation precision. Compared to traditional 3D printing workflows, AR implementation reduced preparation time from several days to under an hour. Surgeons reported improved spatial orientation and efficiency without increased cost or disruption to surgical flow.
CONCLUSION: AR-based lymphatic localization using Meta Quest 3 is a promising, low-cost, real-time alternative to physical 3D models. Early operative use indicates strong potential to enhance surgical planning and intraoperative decision-making. Continued software refinement aims to achieve fully automated, markerless alignment, enabling broader clinical adoption.
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