Extended Reality-Assisted Localization of Lung Nodules in a Hybrid Operating Room: A Prospective Study

Objective To evaluate the feasibility, accuracy, and safety of a novel extended reality-assisted percutaneous localization technique in a hybrid operating room for patients with small pulmonary nodules. Methods In this prospective, single-arm study, twenty adult patients scheduled for video-assisted thoracoscopic surgery sublobar resection for peripheral pulmonary nodules (2 centimeters or less) were enrolled. Participants underwent extended reality-guided percutaneous dye localization under general anesthesia. Patient-specific three-dimensional holographic models were registered using optical markers to guide needle insertion, followed by confirmatory cone-beam computed tomography. Primary outcomes were technical accuracy and procedural safety. Results The extended reality-assisted technique achieved a 90% technical success rate. The mean localization error was 7.9 millimeters in the intention-to-treat population. The procedure was efficient, with a median localization time of 13.5 minutes and a median of one confirmatory cone-beam computed tomography scan. The complication rate was 5%, involving a single case of pneumothorax; no intrapulmonary hemorrhage or air embolism occurred. Conclusions Extended reality-assisted percutaneous localization in a hybrid operating room is feasible and safe, demonstrating acceptable accuracy for small pulmonary nodules. This approach may streamline surgical workflow by enabling continuous needle advancement and reducing repetitive interruptions compared with conventional cone-beam computed tomography guidance.