Augmented Reality: A New Tool To Improve Surgical Accuracy during Laparoscopic Partial Nephrectomy? Preliminary In Vitro and In Vivo Results
Augmented Reality: A New Tool To Improve Surgical Accuracy during Laparoscopic Partial Nephrectomy? Preliminary In Vitro and In Vivo Results
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DOI：
10.1016/j.eururo.2009.05.017
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发表时间：
2009-08-01
期刊：
影响因子：
23.4
通讯作者：
Rassweiler, Jens
中科院分区：
文献类型：
--
作者：
Teber, Dogu;Guven, Selcuk;Rassweiler, Jens
背景：基于增强现实(AR)的软组织导航系统在泌尿外科腹腔镜手术中的应用是一项不断发展的技术。目的：评估一种新的软组织导航系统，该系统旨在增强外科医生的知觉，并在腹腔镜肾部分切除术(LPN)开始前直接提供决策指导。设计、设置和对象：使用定制的导航辅助设备、可移动的能进行锥束成像的C臂和标准的个人计算机。在人工制造的猪实质内肿瘤的体外模型中，评估了内向外跟踪原则的可行性和重复性。同样的算法随后在LPN期间被纳入临床实践。发明：对10个不同的猪肾脏单位以完全相同的方式重复评估全自动内向外跟踪系统。此外，10名患者在一名外科医生的人工AR引导下进行腹膜后LPN。测量：在体外确定导航误差和图像采集时间。结果和局限性：该系统能够导航和叠加虚拟创建的图像和实时图像，误差仅为0.5 mm，全自动初始图像采集需要40ms。手术时间135~195min，平均165min；肿瘤定位时间1327min，平均20min。无一例需要中转开腹手术。最终的组织学检查显示所有10个病例的边缘都没有肿瘤。结论：这种新的AR跟踪系统被证明是有效的，具有合理的误差范围和图像到图像的配准时间。将术前或术中的成像特性实时地安装在视频内窥镜图像上，将简化和提高腹腔镜手术的精确度。(C)由爱思唯尔出版的2009欧洲泌尿学协会。版权所有。
Background: Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique.Objective: To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN).Design, setting, and participants: Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN.Interventions: Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon.Measurements: The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo.Results and limitations: The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 1327 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases.Conclusions: This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures. (C) 2009 European Association of Urology Published by Elsevier B.V. All rights reserved.