[Surgical science].
[Surgical science].
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[外科科学].
DOI：
10.1007/s00534-009-0199-y
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
R. Arbogast
中科院分区：
文献类型：
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作者：
R. Arbogast
背景我们应用了一种新的概念“图像叠加手术”，包括虚拟现实（VR）和增强现实（AR）技术的集成，其中动态3D图像叠加在患者的实际身体表面上，并作为胃肠，肝胆和胰腺手术导航的参考进行评估。两次胃切除术和两次结肠切除术在手术室使用Macintosh和DICOM工作站OsiriX进行图像分析。通过MDCT获得的术前患者信息的原始数据被重建为体绘制，并在手术过程中投影到患者的体表。为了准确配准，OsiriX首先设置为重现患者的身体表面，脐，左，右乳头，腹股沟区的位置坐标被固定为生理标记在身体表面上，以减少位置errors.ResultsThe注册过程是无创和markerless，并在5分钟内完成。图像覆盖导航有助于对胃肠道、肝胆管和胰腺解剖结构中的手术目标进行三维解剖学理解。外科医生能够最大限度地减少凝视的移动，并且可以利用图像辅助而不干扰镊子操作，从而减少与VR的差距。所有手术均能避免意外的器官损伤。在胆道手术中，投影在腹壁上的虚拟胆管造影片可以安全地推进，并识别胆管。对于早期胃癌和结直肠癌，CO2增强MDCT可同时在体表发现腹腔镜下在胃浆膜上通常无法发现的小肿瘤和血管。这提供了准确的重建肿瘤和涉及淋巴结，直接与优化的外科手术procedure.ConclusionsOur非侵入性markerless注册使用生理标记在身体表面上减少后勤工作。当突出显示隐藏的结构时，图像叠加技术是一个有用的工具，可以提供更多信息。
BackgroundWe applied a new concept of “image overlay surgery” consisting of the integration of virtual reality (VR) and augmented reality (AR) technology, in which dynamic 3D images were superimposed on the patient’s actual body surface and evaluated as a reference for surgical navigation in gastrointestinal, hepatobiliary and pancreatic surgery.MethodsWe carried out seven surgeries, including three cholecystectomies, two gastrectomies and two colectomies. A Macintosh and a DICOM workstation OsiriX were used in the operating room for image analysis. Raw data of the preoperative patient information obtained via MDCT were reconstructed to volume rendering and projected onto the patient's body surface during the surgeries. For accurate registration, OsiriX was first set to reproduce the patient body surface, and the positional coordinates of the umbilicus, left and right nipples, and the inguinal region were fixed as physiological markers on the body surface to reduce the positional error.ResultsThe registration process was non-invasive and markerlesss, and was completed within 5 min. Image overlay navigation was helpful for 3D anatomical understanding of the surgical target in the gastrointestinal, hepatobiliary and pancreatic anatomies. The surgeon was able to minimize movement of the gaze and could utilize the image assistance without interfering with the forceps operation, reducing the gap from the VR. Unexpected organ injury could be avoided in all procedures. In biliary surgery, the projected virtual cholangiogram on the abdominal wall could advance safely with identification of the bile duct. For early gastric and colorectal cancer, the small tumors and blood vessels, which usually could not be found on the gastric serosa by laparoscopic view, were simultaneously detected on the body surface by carbon dioxide-enhanced MDCT. This provided accurate reconstructions of the tumor and involved lymph node, directly linked with optimization of the surgical procedures.ConclusionsOur non-invasive markerless registration using physiological markers on the body surface reduced logistical efforts. The image overlay technique is a useful tool when highlighting hidden structures, giving more information.