*Application of Computer-Assisted Surgery System Based on Artificial Intelligence in Pediatric… DOI: http://dx.doi.org/10.5772/intechopen.111509*

actually impossible. However, complete surgical resection of NB is the basis for further treatment, improves the confidence of both physicians and patients in treatment, and is associated with prognosis [23]. Hisense CAS assists in the anatomical analysis of important retroperitoneal vessels to improve surgical resectability and reduce the incidence of surgical complications such as vascular injury and kidney damage.

GN is generally insensitive to chemotherapy, and radical surgical resection is the first choice to confirm the diagnosis and cure. The CT manifestations are often a welldefined, regular-shaped mass, with mostly speckled calcifications in the tumor. The tumor mainly pushes and compresses the surrounding vessels and can grow along the peri-organ space and encircle the blood vessels. Despite the vessels being encircled, the vessels are generally not invaded, and the shape of the vasculature is natural and straight, with few occlusions or stenoses. To avoid sampling errors in aspiration biopsy, to relieve the symptoms of tumor compression already present, and to reduce the possibility of malignant transformation, surgical resection of suspected GN or GNB can be performed. In giant GN/GNB of retroperitoneal origin, the base of the tumor is often the mesenteric root, and involvement of the abdominal aorta, inferior vena cava, and mesenteric arteries is often the main reason for complete resection of the tumor [24]. Hisense CAS aids in the complete resection of the tumor to reduce recurrence and protects important vessels to avoid complications such as bleeding, intestinal obstruction, and intestinal necrosis.

**Figure 5** shows a typical case of a 4-year-old child with an RT. Enhanced CT of the abdomen showed a huge mass-like mixed-density lesion in the abdominal cavity with a maximum cross-section of approximately 123 mm × 85 mm. The radiologists considered the mass to be a tumor (NB?), and there was a very thick blood vessel inside the tumor (**Figure 5A–C**). To clarify the diagnosis and decide on the next treatment, ultrasound-guided abdominal mass aspiration biopsy was performed. The pathologists first considered the mass to be a GN. Thus, surgical resection was the best option for this type of benign tumor. For precise preoperative evaluation, 3D reconstruction was performed using CAS. The reconstructed image clearly showed that the tumor was located in the retroperitoneum, and the mass had a volume of 676.7 ml. The mass was extremely close to the abdominal aorta. The superior mesenteric vein was pushed forwards, and the inferior mesenteric artery passed through the tumor (**Figure 5D–F**). The intraoperative exploration was completely consistent with the preoperative three-dimensional evaluation, and the tumor had a relatively complete fibrous capsule. The superior mesenteric vein was pushed to the front of the tumor. The tumor was close to the abdominal aorta, and the inferior mesenteric artery penetrated the tumor. After splitting the tumor with a CUSA knife, the inferior mesenteric artery that was encased by the tumor could be seen. Arterial pulsation was seen in the exposed inferior mesenteric artery, and the distal sigmoid colon and rectum were ruddy. The tumor section was yellowish-white with a straight and intact vascular sheath, and the postoperative tumor weight was 820 g (**Figure 5G–L**). The tumor was finally diagnosed as a GNB.

#### **4.3 Pediatric mediastinal tumor**

Most mediastinal tumors have an insidious onset and lack specific clinical manifestations, and most of them have no clinical symptoms in the early stage. However, because there are many important organs and structures in the mediastinum, such as the heart, superior vena cava, trachea, and esophagus, the thorax, which has a bony structure, is not as elastic as the abdomen. Because they have less space for

**Figure 5.** *Computer-assisted resection of retroperitoneal tumor (With the permission of the author).*

cushioning, mediastinal masses are prone to compressing important organs and the corresponding symptoms, namely, mediastinal mass syndrome (MMS) [25]. Compared with that in adults, the thoracic cavity in children is relatively smaller in size, and therefore, its complex anatomic-spatial relationships and dense vascularneural structures have brought more challenges for surgical treatment [26].

Mediastinal tissues are of complex origin, and a variety of benign or malignant primary tumors can occur. Neuroblastic tumors are the most common mediastinal tumors in children. In principle, once a mediastinal mass is found, it should be actively treated. Tumors with clear borders and small volumes can be considered for radical surgery. For malignant tumors with high surgical risk, biopsy should be
