2,173 research outputs found

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

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    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

    Uncertainty-Aware Organ Classification for Surgical Data Science Applications in Laparoscopy

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    Objective: Surgical data science is evolving into a research field that aims to observe everything occurring within and around the treatment process to provide situation-aware data-driven assistance. In the context of endoscopic video analysis, the accurate classification of organs in the field of view of the camera proffers a technical challenge. Herein, we propose a new approach to anatomical structure classification and image tagging that features an intrinsic measure of confidence to estimate its own performance with high reliability and which can be applied to both RGB and multispectral imaging (MI) data. Methods: Organ recognition is performed using a superpixel classification strategy based on textural and reflectance information. Classification confidence is estimated by analyzing the dispersion of class probabilities. Assessment of the proposed technology is performed through a comprehensive in vivo study with seven pigs. Results: When applied to image tagging, mean accuracy in our experiments increased from 65% (RGB) and 80% (MI) to 90% (RGB) and 96% (MI) with the confidence measure. Conclusion: Results showed that the confidence measure had a significant influence on the classification accuracy, and MI data are better suited for anatomical structure labeling than RGB data. Significance: This work significantly enhances the state of art in automatic labeling of endoscopic videos by introducing the use of the confidence metric, and by being the first study to use MI data for in vivo laparoscopic tissue classification. The data of our experiments will be released as the first in vivo MI dataset upon publication of this paper.Comment: 7 pages, 6 images, 2 table

    Performance of image guided navigation in laparoscopic liver surgery – A systematic review

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    Background: Compared to open surgery, minimally invasive liver resection has improved short term outcomes. It is however technically more challenging. Navigated image guidance systems (IGS) are being developed to overcome these challenges. The aim of this systematic review is to provide an overview of their current capabilities and limitations. Methods: Medline, Embase and Cochrane databases were searched using free text terms and corresponding controlled vocabulary. Titles and abstracts of retrieved articles were screened for inclusion criteria. Due to the heterogeneity of the retrieved data it was not possible to conduct a meta-analysis. Therefore results are presented in tabulated and narrative format. Results: Out of 2015 articles, 17 pre-clinical and 33 clinical papers met inclusion criteria. Data from 24 articles that reported on accuracy indicates that in recent years navigation accuracy has been in the range of 8–15 mm. Due to discrepancies in evaluation methods it is difficult to compare accuracy metrics between different systems. Surgeon feedback suggests that current state of the art IGS may be useful as a supplementary navigation tool, especially in small liver lesions that are difficult to locate. They are however not able to reliably localise all relevant anatomical structures. Only one article investigated IGS impact on clinical outcomes. Conclusions: Further improvements in navigation accuracy are needed to enable reliable visualisation of tumour margins with the precision required for oncological resections. To enhance comparability between different IGS it is crucial to find a consensus on the assessment of navigation accuracy as a minimum reporting standard

    Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

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    Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules

    25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

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    Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

    Navigated Ultrasound in Laparoscopic Surgery

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    Ultrasound-Augmented Laparoscopy

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    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

    Preoperative liver registration for augmented monocular laparoscopy using backward–forward biomechanical simulation

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    PURPOSE: Augmented reality for monocular laparoscopy from a preoperative volume such as CT is achieved in two steps. The first step is to segment the organ in the preoperative volume and reconstruct its 3D model. The second step is to register the preoperative 3D model to an initial intraoperative laparoscopy image. To date, there does not exist an automatic initial registration method to solve the second step for the liver in the de facto operating room conditions of monocular laparoscopy. Existing methods attempt to solve for both deformation and pose simultaneously, leading to nonconvex problems with no optimal solution algorithms. METHODS: We propose in contrast to break the problem down into two parts, solving for (i) deformation and (ii) pose. Part (i) simulates biomechanical deformations from the preoperative to the intraoperative state to predict the liver’s unknown intraoperative shape by modeling gravity, the abdominopelvic cavity’s pressure and boundary conditions. Part (ii) rigidly registers the simulated shape to the laparoscopy image using contour cues. RESULTS: Our formulation leads to a well-posed problem, contrary to existing methods. This is because it exploits strong environment priors to complement the weak laparoscopic visual cues. CONCLUSION: Quantitative results with in silico and phantom experiments and qualitative results with laparosurgery images for two patients show that our method outperforms the state-of-the-art in accuracy and registration time

    A mixed reality framework for surgical navigation: approach and preliminary results

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    The overarching purpose of this research is to understand whether Mixed Reality can enhance a surgeon’s manipulations skills during minimally invasive procedures. Minimally-invasive surgery (MIS) utilizes small cuts in the skin - or sometimes natural orifices - to deploy instruments inside a patient’s body, while a live video feed of the surgical site is provided by an endoscopic camera and displayed on a screen. MIS is associated with many benefits: small scars, less pain and shorter hospitalization time as compared to traditional open surgery. However, these benefits come at a cost: because surgeons have to work by looking at a monitor, and not down on their own hands, MIS disrupts their eye-hand coordination and makes even simple surgical maneuvers challenging to perform. In this study, we wish to use Mixed Reality technology to superimpose anatomical models over the surgical site and explore if it can be used to mitigate this problem
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