Understandable Pre-op, Less Suffering Intra-op, Clear Post-op: Shanghai Chest Hospital Builds Digital One-Stop Thoracic Surgery System

Background

Pulmonary nodules suspicious for early-stage lung cancer are increasingly detected through widespread CT screening. Traditional preoperative localization for sublobar resection often relies on CT-guided percutaneous hook-wire placement performed under local anesthesia while the patient is awake. This approach can involve significant pain, patient anxiety, additional radiation exposure, waiting time between localization and surgery, and risks such as pneumothorax.

What was achieved

Cheng Xinghua's team from the tumor surgery department at Shanghai Chest Hospital conducted a multicenter randomized clinical trial evaluating single-encounter augmented reality (AR)-guided localization. The study was published online in JAMA Surgery on July 8, 2026. According to reports, it is the first to confirm the clinical value of AR navigation combined with AI for early lung cancer surgery. A JAMA Surgery commentary noted it as the world's first demonstration that mixed reality technology integrated with artificial intelligence can be applied in thoracic surgery.

The trial enrolled 296 patients across five centers in China between August 2024 and September 2025, with 270 included in the modified intention-to-treat analysis. The primary outcome of successful sublobar resection (R0 with adequate margins) was achieved in 98.5% of the AR group and 99.3% of the CT group, meeting non-inferiority criteria. Secondary benefits in the AR arm included lower median radiation exposure (456.50 vs 1260.11 mGy·cm), reduced pain scores (0 vs 5), shorter puncture times (0.63 vs 6.50 min), shorter localization-to-incision intervals (2.00 vs 33.50 min), and fewer complications such as pneumothorax (reported at 29.4% in the CT group).

Building on these results, the hospital established a digital one-stop thoracic surgery system integrating mixed reality and AI across the pre-, intra- and post-operative phases centered on patient experience.

How it works

Before surgery, AI processes standard CT scans to generate a three-dimensional model of the patient's lungs, airways, blood vessels and the nodule. This interactive 3D visualization is shown to the patient on a digital screen. The surgeon can rotate and point to features, helping the patient clearly understand the nodule's position, its characteristics and the planned surgical approach, addressing the common difficulty patients have interpreting conventional two-dimensional CT images.

In the operating room, the patient receives general anesthesia. The surgeon dons AR glasses that register with markers and overlay a real-time holographic 3D image directly onto the patient's anatomy. This provides precise guidance for localization and resection, displaying the nodule, optimal paths and nearby critical structures without requiring separate painful localization steps or prolonged waiting. The procedure transitions seamlessly into video-assisted thoracoscopic sublobar resection.

After surgery, the same 3D reconstruction techniques allow assessment of the resected area, remaining lung tissue and function. Follow-up visits incorporate these visualizations and maintain a digital record that updates over time, supporting long-term monitoring.

What it means for international patients

Shanghai Chest Hospital maintains an international medical department that can facilitate consultations for overseas patients, with options to arrange language interpretation and translated reports. International patients seeking care involving the hospital's digital thoracic surgery approaches for pulmonary nodules or early lung cancer must confirm eligibility, current availability of the specific techniques and all treatment details directly with the hospital, as individual suitability depends on medical assessment.

About the hospital

Shanghai Chest Hospital, also known as Shanghai Chest Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, is located at 241 Huaihai West Road in Shanghai's Xuhui District. Founded in 1957, it is a Grade 3A tertiary specialized hospital focused on the diagnosis and treatment of thoracic and cardiovascular diseases, including lung, esophageal, tracheal and mediastinal conditions. It holds national key clinical specialty designations in thoracic surgery, cardiovascular medicine and cardiac and great vessel surgery.

The hospital is known for high volumes of complex minimally invasive thoracic procedures and has been a leader in robotic thoracic surgery. It serves as a teaching and research institution and operates an international medical service to support patients from abroad.