Recent trends, technical concepts and components of computer-assisted orthopedic surgery systems: A comprehensive review

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.Web of Science1923art. no. 519

Video-based assistance system for training in minimally invasive surgery

In this paper, the development of an assisting system for laparoscopic surgical training is presented. With this system, we expect to facilitate the training process at the first stages of training in laparoscopic surgery and to contribute to an objective evaluation of surgical skills. To achieve this, we propose the insertion of multimedia contents and outlines of work adapted to the level of experience of trainees and the detection of the movements of the laparoscopic instrument into the monitored image. A module to track the instrument is implemented focusing on the tip of the laparoscopic tool. This tracking method does not need the presence of artificial marks or special colours to distinguish the instruments. Similarly, the system has another method based on visual tracking to localize support multimedia content in a stable position of the field of vision. Therefore, this position of the support content is adapted to the movements of the camera or the working area. Experimental results are presented to show the feasibility of the proposed system for assisting in laparoscopic surgical training

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

One of the main challenges for computer-assisted surgery (CAS) is to determine the intra-opera- tive morphology and motion of soft-tissues. This information is prerequisite to the registration of multi-modal patient-specific data for enhancing the surgeon’s navigation capabilites by observ- ing beyond exposed tissue surfaces and for providing intelligent control of robotic-assisted in- struments. In minimally invasive surgery (MIS), optical techniques are an increasingly attractive approach for in vivo 3D reconstruction of the soft-tissue surface geometry. This paper reviews the state-of-the-art methods for optical intra-operative 3D reconstruction in laparoscopic surgery and discusses the technical challenges and future perspectives towards clinical translation. With the recent paradigm shift of surgical practice towards MIS and new developments in 3D opti- cal imaging, this is a timely discussion about technologies that could facilitate complex CAS procedures in dynamic and deformable anatomical regions

Virtual Reality Simulator for Training in Myringotomy with Tube Placement

Myringotomy refers to a surgical incision in the eardrum, and it is often followed by ventilation tube placement to treat middle-ear infections. The procedure is difficult to learn; hence, the objectives of this work were to develop a virtual-reality training simulator, assess its face and content validity, and implement quantitative performance metrics and assess construct validity. A commercial digital gaming engine (Unity3D) was used to implement the simulator with support for 3D visualization of digital ear models and support for major surgical tasks. A haptic arm co-located with the stereo scene was used to manipulate virtual surgical tools and to provide force feedback. A questionnaire was developed with 14 face validity questions focusing on realism and 6 content validity questions focusing on training potential. Twelve participants from the Department of Otolaryngology were recruited for the study. Responses to 12 of the 14 face validity questions were positive. One concern was with contact modeling related to tube insertion into the eardrum, and the second was with movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses were positive, 21% were neutral, and 15% were negative. In the final phase of this work, automated performance metrics were programmed and a construct validity study was conducted with 11 participants: 4 senior Otolaryngology consultants and 7 junior Otolaryngology residents. Each participant performed 10 procedures on the simulator and metrics were automatically collected. Senior Otolaryngologists took significantly less time to completion compared to junior residents. Junior residents had 2.8 times more errors as compared to experienced surgeons. The senior surgeons also had significantly longer incision lengths, more accurate incision angles, and lower magnification keeping both the umbo and annulus in view. All metrics were able to discriminate senior Otolaryngologists from junior residents with a significance of p \u3c 0.002. The simulator has sufficient realism, training potential and performance discrimination ability to warrant a more resource intensive skills transference study

Image-guided port placement for minimally invasive cardiac surgery

Minimally invasive surgery is becoming popular for a number of interventions. Use of robotic surgical systems in coronary artery bypass intervention offers many benefits to patients, but is however limited by remaining challenges in port placement. Choosing the entry ports for the robotic tools has a large impact on the outcome of the surgery, and can be assisted by pre-operative planning and intra-operative guidance techniques. In this thesis, pre-operative 3D computed tomography (CT) imaging is used to plan minimally invasive robotic coronary artery bypass (MIRCAB) surgery. From a patient database, port placement optimization routines are implemented and validated. Computed port placement configurations approximated past expert chosen configurations with an error of 13.7 ±5.1 mm. Following optimization, statistical classification was used to assess patient candidacy for MIRCAB. Various pattern recognition techniques were used to predict MIRCAB success, and could be used in the future to reduce conversion rates to conventional open-chest surgery. Gaussian, Parzen window, and nearest neighbour classifiers all proved able to detect ‘candidate’ and ‘non-candidate’ MIRCAB patients. Intra-operative registration and laser projection of port placements was validated on a phantom and then evaluated in four patient cases. An image-guided laser projection system was developed to map port placement plans from pre-operative 3D images. Port placement mappings on the phantom setup were accurate with an error of 2.4 ± 0.4 mm. In the patient cases, projections remained within 1 cm of computed port positions. Misregistered port placement mappings in human trials were due mainly to the rigid-body registration assumption and can be improved by non-rigid techniques. Overall, this work presents an integrated approach for: 1) pre-operative port placement planning and classification of incoming MIRCAB patients; and 2) intra-operative guidance of port placement. Effective translation of these techniques to the clinic will enable MIRCAB as a more efficacious and accessible procedure

Automation of tissue piercing using circular needles and vision guidance for computer aided laparoscopic surgery

Abstract—Despite the fact that minimally invasive robotic surgery provides many advantages for patients, such as reduced tissue trauma and shorter hospitalization, complex tasks (e.g. tissue piercing or knot-tying) are still time-consuming, error-prone and lead to quicker fatigue of the surgeon. Automating these recurrent tasks could greatly reduce total surgery time for patients and disburden the surgeon while he can focus on higher level challenges. This work tackles the problem of autonomous tissue piercing in robot-assisted laparoscopic surgery with a circular needle and general purpose surgical instruments. To command the instruments to an incision point, the surgeon utilizes a laser pointer to indicate the stitching area. A precise positioning of the needle is obtained by means of a switching visual servoing approach and the subsequent stitch is performed in a circular motion. Index Terms—robot surgery, minimally invasive surgery, tissue piercing, visual servoing I

Metrics for Evaluating Surgical Microscope Usage During Myringotomy

Abstract Although teaching and learning surgical microscope manoeuvring is a fundamental step in middle ear surgical training, currently there is no objective method to teach or assess this skill. This thesis presents an experimental study designed to implement and test sets of metrics capable of numerically evaluating microscope manoeuvrability and qualitatively assessing surgical expertise of a subject during a middle ear surgery called myringotomy. The experiment involved performing a myringotomy on a fixed cadaveric ear. As participants, experienced ear-nose-throat (ENT) surgeons and ENT surgical residents were invited. While performing the procedure, their microscope manoeuvring motions were captured as translational and angular coordinates using an optical tracker. These data were analyzed in terms of motion path length, velocity, acceleration, jitter, manoeuvring volume, smoothness, rotation and time. Participants’ hand motion, body posture and microscopic view were also video recorded to qualitatively assess their surgical expertise. Several metrics were statistically identified as discriminatory. These metrics will be incorporated into a myringotomy surgical simulator to train ENT residents

INFORMATION TECHNOLOGY FOR NEXT-GENERATION OF SURGICAL ENVIRONMENTS

Minimally invasive surgeries (MIS) are fundamentally constrained by image quality,access to the operative field, and the visualization environment on which thesurgeon relies for real-time information. Although invasive access benefits the patient,it also leads to more challenging procedures, which require better skills andtraining. Endoscopic surgeries rely heavily on 2D interfaces, introducing additionalchallenges due to the loss of depth perception, the lack of 3-Dimensional imaging,and the reduction of degrees of freedom.By using state-of-the-art technology within a distributed computational architecture,it is possible to incorporate multiple sensors, hybrid display devices, and3D visualization algorithms within a exible surgical environment. Such environmentscan assist the surgeon with valuable information that goes far beyond what iscurrently available. In this thesis, we will discuss how 3D visualization and reconstruction,stereo displays, high-resolution display devices, and tracking techniques arekey elements in the next-generation of surgical environments

A Review of Virtual Reality Based Training Simulators for Orthopaedic Surgery

This review presents current virtual reality based training simulators for hip, knee and other orthopaedic surgery, including elective and trauma surgical procedures. There have not been any reviews focussing on hip and knee orthopaedic simulators. A comparison of existing simulator features is provided to identify what is missing and what is required to improve upon current simulators. In total 11 total hip replacement pre-operative planning tools were analysed, plus 9 hip trauma fracture training simulators. Additionally 9 knee arthroscopy simulators and 8 other orthopaedic simulators were included for comparison. The findings are that for orthopaedic surgery simulators in general, there is increasing use of patient-specific virtual models which reduce the learning curve. Modelling is also being used for patient-specific implant design and manufacture. Simulators are being increasingly validated for assessment as well as training. There are very few training simulators available for hip replacement, yet more advanced virtual reality is being used for other procedures such as hip trauma and drilling. Training simulators for hip replacement and orthopaedic surgery in general lag behind other surgical procedures for which virtual reality has become more common. Further developments are required to bring hip replacement training simulation up to date with other procedures. This suggests there is a gap in the market for a new high fidelity hip replacement and resurfacing training simulator