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

Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

Este artículo presenta una revisión acerca de la neurocirugía, los asistentes robóticos en este tipo de procedimiento, y el tratamiento que se le da al problema del desplazamiento que sufre el tejido cerebral, incluyendo las técnicas para la obtención de imágenes médicas. Se abarca de manera especial el fenómeno del desplazamiento cerebral, comúnmente conocido como brain shift, el cual causa pérdida de referencia entre las imágenes preoperatorias y los volúmenes a tratar durante la cirugía guiada por imágenes médicas. Hipotéticamente, con la predicción y corrección del brain shift sobre el sistema de neuronavegación, se podrían planear y seguir trayectorias de mínima invasión, lo que conllevaría a minimizar el daño a los tejidos funcionales y posiblemente a reducir la morbilidad y mortalidad en estos delicados y exigentes procedimientos médicos, como por ejemplo, en la extirpación de un tumor cerebral. Se mencionan también otros inconvenientes asociados a la neurocirugía y se muestra cómo los sistemas robotizados han ayudado a solventar esta problemática. Finalmente se ponen en relieve las perspectivas futuras de esta rama de la medicina, la cual desde muchas disciplinas busca tratar las dolencias del principal órgano del ser humano.This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines

ADVANCED IMAGING AND ROBOTICS TECHNOLOGIES FOR MEDICAL APPLICATIONS

Due to the importance of surgery in the medical field, a large amount of research has been conducted in this area. Imaging and robotics technologies provide surgeons with the advanced eye and hand to perform their surgeries in a safer and more accurate manner. Recently medical images have been utilized in the operating room as well as in the diagnostic stage. If the image to patient registration is done with sufficient accuracy, medical images can be used as "a map" for guidance to the target lesion. However, the accuracy and reliability of the surgical navigation system should be sufficiently verified before applying it to the patient. Along with the development of medical imaging, various medical robots have also been developed. In particular, surgical robots have been researched in order to reach the goal of minimal invasiveness. The most important factors to consider are determining the demand, the strategy for their use in operating procedures, and how it aids patients. In addition to the above considerations, medical doctors and researchers should always think from the patient's point of view. In this article, the latest medical imaging and robotic technologies focusing on surgical applications are reviewed based upon the factors described in the above. © 2011 Copyright Taylor and Francis Group, LLC.1

Image-guided surgery and novel intraoperative devices for enhanced visualisation in general and paediatric surgery: a review

Fluorescence guided surgery, augmented reality, and intra-operative imaging devices are rapidly pervading the field of surgical interventions, equipping the surgeon with powerful tools capable of enhancing the surgical visualisation of anatomical normal and pathological structures. There is a wide range of possibilities in the adult population to use these novel technologies and devices in the guidance for surgical procedures and minimally invasive surgeries. Their applications and their use have also been increasingly growing in the field of paediatric surgery, where the detailed visualisation of small anatomical structures could reduce procedure time, minimising surgical complications and ultimately improve the outcome of surgery. This review aims to illustrate the mechanisms underlying these innovations and their main applications in the clinical setting

Laparoscopic Pancreas Surgery: Image Guidance Solutions

Pancreatic ductal adenocarcinoma (PDA) is the fourth leading cause of cancer-related deaths. Surgery is the only viable treatment, but irradical resection rates are still high. Laparoscopic pancreatic surgery has some technical limitations for surgeons and tumor identification may be challenging. Image-guided techniques provide intraoperative margin assessment and visualization methods, which may be advantageous in guiding the surgeon to achieve curative resections and therefore improve the surgical outcomes. In this chapter, current available laparoscopic surgical approaches and image-guided techniques for pancreatic surgery are reviewed. Surgical outcomes of pancreaticoduodenectomy and distal pancreatectomy performed by laparoscopy, laparoendoscopic single-site surgery (LESS), and robotic surgery are included and analyzed. Besides, image-guided techniques such as intraoperative near-infrared fluorescence imaging and surgical navigation are presented as emerging techniques. Results show that minimally invasive procedures reported a reduction of blood loss, reduced length of hospital stay, and positive resection margins, as well as an improvement in spleen-preserving rates, when compared to open surgery. Studies reported that fluorescence-guided pancreatic surgery might be beneficial in cases where the pancreatic anatomy is difficult to identify. The first approach of a surgical navigation system for guidance during pancreatic resection procedures is presented, combining preoperative images (CT and MRI) with intraoperative laparoscopic ultrasound imaging

Towards Transcervical Ultrasound Image Guidance for Transoral Robotic Surgery

Purpose: Trans-oral robotic surgery (TORS) using the da Vinci surgical robot is a new minimally-invasive surgery method to treat oropharyngeal tumors, but it is a challenging operation. Augmented reality (AR) based on intra-operative ultrasound (US) has the potential to enhance the visualization of the anatomy and cancerous tumors to provide additional tools for decision-making in surgery. Methods: We propose and carry out preliminary evaluations of a US-guided AR system for TORS, with the transducer placed on the neck for a transcervical view. Firstly, we perform a novel MRI-transcervical 3D US registration study. Secondly, we develop a US-robot calibration method with an optical tracker and an AR system to display the anatomy mesh model in the real-time endoscope images inside the surgeon console. Results: Our AR system reaches a mean projection error of 26.81 and 27.85 pixels for the projection from the US to stereo cameras in a water bath experiment. The average target registration error for MRI to 3D US is 8.90 mm for the 3D US transducer and 5.85 mm for freehand 3D US, and the average distance between the vessel centerlines is 2.32 mm. Conclusion: We demonstrate the first proof-of-concept transcervical US-guided AR system for TORS and the feasibility of trans-cervical 3D US-MRI registration. Our results show that trans-cervical 3D US is a promising technique for TORS image guidance.Comment: 12 pages, 8 figures. Accepted by Information Processing for Computer Assisted Interventions (IPCAI 2023

Enter the matrix:On how to improve thyroid nodule management using 3D ultrasound

Roughly two-thirds of the adult population has a thyroid nodule, of which 90% are benign. Of the adults that have a nodule, approximately 5% will experience symptoms that include a feeling of a marble stuck in the throat, difficulty swallowing and breathing, and cosmetic complaints. Thyroid nodule management primarily makes use of ultrasound as the imaging modality for diagnosis, image guidance during therapy (radiofrequency ablation i.e. RFA), and follow-up. Although ultrasound is relatively easy to apply, it is hard to standardize for repeated measurements and across various users. Further, RFA can benefit from 3D imaging information and a planning and navigation system to improve clinical outcome. These challenges may be overcome by using 3D ultrasound. In this thesis, two phantoms were created on which these methods can be developed. Further, it offers insight into the use of 2D and 3D ultrasound for thyroid nodule management.To assess the impact of changes to an intervention, a baseline was determined of the effectiveness of RFA in Dutch hospitalsUsing a simple phantom, we have shown that utilizing a volume-based measurement technique, that the matrix transducer offers, results in improved measurement accuracy. The more complex, anthropomorphic, phantom serves as a platform on which thermal treatments, such as RFA, can be improved. Using this phantom, we have shown that the impact of 2D and 3D ultrasound on RFA efficacy does not differ from one another; however, the matrix transducer might be more user-friendly for needle placement due to the dual-plane imaging. An additional use case for these phantoms is their capacity to compare dominant and non-dominant hand ablations, as well as serve as a training platform. Additional research is required that employs more operators to find stronger evidence supporting a difference between the ablating hands and the difference in effect of 2D and 3D ultrasound guidance.To make full use of 3D ultrasound, stitching algorithms should be integrated into the ultrasound systems to acquire larger volumes. These can then be processed by deep-learning algorithms for use in computer-aided diagnosis and intervention systems. To further improve the applicability of 3D ultrasound in the clinic, integrating analysis methods such as 3D elastography and 3D Doppler is suggested

Towards fluoro-free interventions: Using radial intracardiac ultrasound for vascular navigation

Transcatheter cardio-vascular interventions have the advantage of patient safety,reduced surgery time, and minimal trauma to the patient\u27s body. Transcathetherinterventions, which are performed percutaneously, suffer from the lack of direct line-of-sight with the surgical tools and the patient anatomy. Therefore, such interventionalprocedures rely heavily on image guidance for navigating towards and deliveringtherapy at the target site. Vascular navigation via the inferior vena cava (IVC), from thegroin to the heart, is an imperative part of most transcatheter cardiovascularinterventions such as valve repair surgeries and ablation therapy. Traditionally, the IVCis navigated using fluoroscopic techniques such as angiography or CT venography.These X-ray based techniques can have detrimental effects on the patient as well asthe surgical team, causing increased radiation exposure, increased risk of cancer, fetaldefects, eye cataracts. The use of heavy lead apron has also been reported to causeback pain and spine issues thus leading to interventionalist’s disc disease. We proposethe use of a catheter-based ultrasound augmented with electromagnetic (EM) trackingtechnology to generate a vascular roadmap in real-time and perform navigation withoutharmful radiation. In this pilot study, we use intracardiac echocardiography (ICE) and tracking technology to reconstruct a vessel from a phantom in a 3D virtual space. Thispaper presents a pilot phantom study on ICE-based vessel reconstruction anddemonstrates how the proposed ultrasound-based navigation will appear in a virtualspace, by navigating a tracked guidewire within the vessels in the phantom without anyradiation-based imaging. The geometric accuracy is assessed using a CT scan of thephantom, with a Dice coefficient of 0.79. The average distance between the surface ofthe two models comes out to be 1.7 ± 1.12mm