Real-time image guidance for robot-assisted laparoscopic surgery

肾癌是第六种最常见的恶性肿瘤，占加拿大癌症相关死亡的2.6%。2007年，4900名加拿大人被诊断出患有肾癌，其中1650人死于肾癌。最常用的治疗肾癌的手术是腹腔镜下的根治性肾切除术，它涉及整个肾脏的切除；然而，另一种方法是腹腔镜下的部分肾切除术，它只允许切除含有肿瘤的肾脏部分。不幸的是，这是一项具有技术挑战性的手术，有可能出现严重的并发症。此过程可以手动执行，也可以在机器人的帮助下执行。在可视化关键解剖结构方面仍然存在挑战，这些解剖结构隐藏在腹腔镜摄像机之外。这项研究的长期目标是开发一种技术，将超声成像结合到机器人辅助的腹腔镜检查中，以进行实时指导。特别是，这笔赠款将开发获取和分析超声图像的新技术，以提高用于癌症治疗的机器人肾部分切除术的准确性、速度和成功率。对患者的直接好处包括减少积极的手术切缘，保护重要结构免受损伤，增加患者的存活率。这些技术将使用手术前和手术中拍摄的多种类型的超声图像。目前，机器人腹腔镜肾切除术是由立体摄像系统引导的，因此，结合超声波和计算机断层扫描，以及关键的解剖信息，将为外科医生提供更好的指导。这一新方法将使肿瘤、血管、神经和实体器官的位置能够更准确地可视化。这项研究中开发的工具将适用于其他执行机器人腹腔镜手术的群体以及标准的腹腔镜手术。重点研究领域包括图像配准、弹性成像、数据融合和手术用户界面。在本项目期间，将在这些领域培训7名高素质人员。

Kidney cancer is the sixth most frequently diagnosed malignancy overall, and is responsible for 2.6% of cancer-related death in Canada. In 2007, 4,900 Canadians were diagnosed with kidney cancer and 1,650 succumbed to it. The most commonly recruited procedure for kidney cancer is laparoscopic radical nephrectomy, which involves removal of the entire kidney; however, an alternative to this is laparoscopic partial nephrectomy which allows removal of only the segment of kidney containing the tumour. Unfortunately, this is a technically challenging operation with the potential for serious complications. This procedure can be performed manually or with robotic assistance. Challenges remain in visualizing the critical anatomy hidden from the laparoscopy camera. The long-term objective of this research is to develop the technology to incorporate ultrasound imaging into robotic assisted laparoscopy for real-time guidance. In particular, this grant will develop novel techniques for the acquisition and analysis of ultrasound images to improve the accuracy, speed and success of robotic partial nephrectomies for cancer treatment. Direct benefits to patients include reduction of positive surgical margins, preservation of vital structures from injury and increased patient survival. The techniques will use multiple types of ultrasound images taken before and during surgery. Robotic laparoscopic surgery for nephrectomy is currently guided by a stereo camera system, so incorporation of ultrasound and computed tomography, along with key anatomical information, will provide enhanced guidance for the surgeon. This new approach will enable more accurate visualization of the locations of tumours, blood vessels, nerves and solid organs. The tools developed in this research will be applicable to other groups performing robotic laparoscopic surgery as well as standard laparoscopic surgery. Key research areas include image registration, elastography, data fusion and surgical user interfaces. Seven highly qualified personnel will be trained in these areas over the period of this project.