Introduction: Accurate diagnosis of peripheral pulmonary lesions is crucial in respiratory medicine. Radial endobronchial ultrasound (R-EBUS), navigation technologies, and ultrathin bronchoscopes have progressively enhanced distal airway access. Mixed reality (MR) offers a hands-free method for visualizing and manipulating CT-derived three-dimensional (3D) anatomy within the operator’s field of view. This retrospective study aimed to describe the technical feasibility and safety of intraprocedural MR-based holographic virtual bronchoscopy (VB) use. Methods: This study included patients who underwent bronchoscopy for peripheral pulmonary lesions using an MR-based 3D holographic VB system. CT datasets were converted into 3D polygon models and displayed on a HoloLens 2 headset. Operators/assistants intraprocedurally referenced and manipulated the hologram while advancing the bronchoscope. Procedural variables, R-EBUS findings, biopsy techniques, diagnostic yield, and complications were evaluated. Results: Eighteen patients were included. A direct bronchus sign was present in 12 lesions. The median bronchial generation that could be visualized on CT and 3D-VB was six, whereas bronchoscopy enabled advancement to a median of five generations. Radial EBUS demonstrated a within-lesion position in 13 cases. Biopsy techniques included forceps biopsy, cryobiopsy, and TBNA. The overall diagnostic yield was 72.2% (13/18), with malignant disease accounting for the majority of diagnoses. One patient developed mild pneumothorax, which resolved without drainage. Conclusion: MR-based holographic VB enabled real-time, hands-free 3D anatomical referencing without interrupting the procedure. Further prospective studies are warranted to assess procedural benefits and potential integration with other bronchoscopic modalities and devices.
Ina et al. (Fri,) studied this question.