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

Real-time 3D tracking of laparoscopy training instruments for assessment and feedback

Assessment of minimally invasive surgical skills is a non-trivial task, usually requiring the presence and time of expert observers, including subjectivity and requiring special and expensive equipment and software. Although there are virtual simulators that provide self-assessment features, they are limited as the trainee loses the immediate feedback from realistic physical interaction. The physical training boxes, on the other hand, preserve the immediate physical feedback, but lack the automated self-assessment facilities. This study develops an algorithm for real-time tracking of laparoscopy instruments in the video cues of a standard physical laparoscopy training box with a single fisheye camera. The developed visual tracking algorithm recovers the 3D positions of the laparoscopic instrument tips, to which simple colored tapes (markers) are attached. With such system, the extracted instrument trajectories can be digitally processed, and automated self-assessment feedback can be provided. In this way, both the physical interaction feedback would be preserved and the need for the observance of an expert would be overcome. Real-time instrument tracking with a suitable assessment criterion would constitute a significant step towards provision of real-time (immediate) feedback to correct trainee actions and show them how the action should be performed. This study is a step towards achieving this with a low cost, automated, and widely applicable laparoscopy training and assessment system using a standard physical training box equipped with a fisheye camera

Ultrasound-Augmented Laparoscopy

Laparoscopic surgery is perhaps the most common minimally invasive procedure for many diseases in the abdomen. Since the laparoscopic camera provides only the surface view of the internal organs, in many procedures, surgeons use laparoscopic ultrasound (LUS) to visualize deep-seated surgical targets. Conventionally, the 2D LUS image is visualized in a display spatially separate from that displays the laparoscopic video. Therefore, reasoning about the geometry of hidden targets requires mentally solving the spatial alignment, and resolving the modality differences, which is cognitively very challenging. Moreover, the mental representation of hidden targets in space acquired through such cognitive medication may be error prone, and cause incorrect actions to be performed. To remedy this, advanced visualization strategies are required where the US information is visualized in the context of the laparoscopic video. To this end, efficient computational methods are required to accurately align the US image coordinate system with that centred in the camera, and to render the registered image information in the context of the camera such that surgeons perceive the geometry of hidden targets accurately. In this thesis, such a visualization pipeline is described. A novel method to register US images with a camera centric coordinate system is detailed with an experimental investigation into its accuracy bounds. An improved method to blend US information with the surface view is also presented with an experimental investigation into the accuracy of perception of the target locations in space

Visual SLAM for Measurement and Augmented Reality in Laparoscopic Surgery

In spite of the great advances in laparoscopic surgery, this type of surgery still shows some difficulties during its realization, mainly caused by its complex maneuvers and, above all, by the loss of the depth perception. Unlike classical open surgery --laparotomy-- where surgeons have direct contact with organs and a complete 3D perception, laparoscopy is carried out by means of specialized instruments, and a monocular camera (laparoscope) in which the 3D scene is projected into a 2D plane --image. The main goal of this thesis is to face with this loss of depth perception by making use of Simultaneous Localization and Mapping (SLAM) algorithms developed in the fields of robotics and computer vision during the last years. These algorithms allow to localize, in real time (25 $\thicksim$ 30 frames per second), a camera that moves freely inside an unknown rigid environment while, at the same time, they build a map of this environment by exploiting images gathered by that camera. These algorithms have been extensively validated both in man-made environments (buildings, rooms, ...) and in outdoor environments, showing robustness to occlusions, sudden camera motions, or clutter. This thesis tries to extend the use of these algorithms to laparoscopic surgery. Due to the intrinsic nature of internal body images (they suffer from deformations, specularities, variable illumination conditions, limited movements, ...), applying this type of algorithms to laparoscopy supposes a real challenge. Knowing the camera (laparoscope) location with respect to the scene (abdominal cavity) and the 3D map of that scene opens new interesting possibilities inside the surgical field. This knowledge enables to do augmented reality annotations directly on the laparoscopic images (e.g. alignment of preoperative 3D CT models); intracavity 3D distance measurements; or photorealistic 3D reconstructions of the abdominal cavity recovering synthetically the lost depth. These new facilities provide security and rapidity to surgical procedures without disturbing the classical procedure workflow. Hence, these tools are available inside the surgeon's armory, being the surgeon who decides to use them or not. Additionally, knowledge of the camera location with respect to the patient's abdominal cavity is fundamental for future development of robots that can operate automatically since, knowing this location, the robot will be able to localize other tools controlled by itself with respect to the patient. In detail, the contributions of this thesis are: - To demonstrate the feasibility of applying SLAM algorithms to laparoscopy showing experimentally that using robust data association is a must. - To robustify one of these algorithms, in particular the monocular EKF-SLAM algorithm, by adapting a relocalization system and improving data association with a robust matching algorithm. - To develop of a robust matching method (1-Point RANSAC algorithm). - To develop a new surgical procedure to ease the use of visual SLAM in laparoscopy. - To make an extensive validation of the robust EKF-SLAM (EKF + relocalization + 1-Point RANSAC) obtaining millimetric errors and working in real time both on simulation and real human surgeries. The selected surgery has been the ventral hernia repair. - To demonstrate the potential of these algorithms in laparoscopy: they recover synthetically the depth of the operative field which is lost by using monocular laparoscopes, enable the insertion of augmented reality annotations, and allow to perform distance measurements using only a laparoscopic tool (to define the real scale) and laparoscopic images. - To make a clinical validation showing that these algorithms allow to shorten surgical times of operations and provide more security to the surgical procedures

Intention recognition for gaze controlled robotic minimally invasive laser ablation

Eye tracking technology has shown promising results for allowing hands-free control of robotically-mounted cameras and tools. However existing systems present only limited capabilities in allowing the full range of camera motions in a safe, intuitive manner. This paper introduces a framework for the recognition of surgeon intention, allowing activation and control of the camera through natural gaze behaviour. The system is resistant to noise such as blinking, while allowing the surgeon to look away safely at any time. Furthermore, this paper presents a novel approach to control the translation of the camera along its optical axis using a combination of eye tracking and stereo reconstruction. Combining eye tracking and stereo reconstruction allows the system to determine which point in 3D space the user is fixating, enabling a translation of the camera to achieve the optimal viewing distance. In addition, the eye tracking information is used to perform automatic laser targeting for laser ablation. The desired target point of the laser, mounted on a separate robotic arm, is determined with the eye tracking thus removing the need to manually adjust the laser's target point before starting each new ablation. The calibration methodology used to obtain millimetre precision for the laser targeting without the aid of visual servoing is described. Finally, a user study validating the system is presented, showing clear improvement with median task times under half of those of a manually controlled robotic system

The Design of a Haptic Device for Training and Evaluating Surgeon and Novice Laparoscopic Movement Skills

As proper levels of force application are necessary to ensure patient safety, and training hours with an expert on live subjects are difficult, enhanced computer-based training is needed to teach the next generation of surgeons. Considering the role of touch in surgery, there is a need for a device capable of discerning the haptic ability of surgical trainees. This need is amplified by minimally invasive surgical techniques where a surgeon\u27s sense of tissue properties comes not directly through their own hands but indirectly through the tools. A haptic device capable of producing a realistic range of forces and motions that can be used to test the ability of users to replicate salient forces in specific maneuvers is proposed. This device also provides the opportunity to use inexpensive haptic trainers to educate surgeons about proper force application. A novel haptic device was designed and built to provide a simplified analogy of the forces and torques felt during free tool motion and constrained pushing, sweep with laparoscopic instruments. The device is realized as a single-degree-of-freedom robotic system controlled using real-time computer hardware and software. The details of the device design and the results of testing the design against the specifications are presented. A significant achievement in the design is the use of a two-camera vision system to sense the user placement of the input device. The capability of the device as a first-order screening tool to distinguish between novices and expert surgeons is described