60 research outputs found

    Exploiting Temporal Image Information in Minimally Invasive Surgery

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    Minimally invasive procedures rely on medical imaging instead of the surgeons direct vision. While preoperative images can be used for surgical planning and navigation, once the surgeon arrives at the target site real-time intraoperative imaging is needed. However, acquiring and interpreting these images can be challenging and much of the rich temporal information present in these images is not visible. The goal of this thesis is to improve image guidance for minimally invasive surgery in two main areas. First, by showing how high-quality ultrasound video can be obtained by integrating an ultrasound transducer directly into delivery devices for beating heart valve surgery. Secondly, by extracting hidden temporal information through video processing methods to help the surgeon localize important anatomical structures. Prototypes of delivery tools, with integrated ultrasound imaging, were developed for both transcatheter aortic valve implantation and mitral valve repair. These tools provided an on-site view that shows the tool-tissue interactions during valve repair. Additionally, augmented reality environments were used to add more anatomical context that aids in navigation and in interpreting the on-site video. Other procedures can be improved by extracting hidden temporal information from the intraoperative video. In ultrasound guided epidural injections, dural pulsation provides a cue in finding a clear trajectory to the epidural space. By processing the video using extended Kalman filtering, subtle pulsations were automatically detected and visualized in real-time. A statistical framework for analyzing periodicity was developed based on dynamic linear modelling. In addition to detecting dural pulsation in lumbar spine ultrasound, this approach was used to image tissue perfusion in natural video and generate ventilation maps from free-breathing magnetic resonance imaging. A second statistical method, based on spectral analysis of pixel intensity values, allowed blood flow to be detected directly from high-frequency B-mode ultrasound video. Finally, pulsatile cues in endoscopic video were enhanced through Eulerian video magnification to help localize critical vasculature. This approach shows particular promise in identifying the basilar artery in endoscopic third ventriculostomy and the prostatic artery in nerve-sparing prostatectomy. A real-time implementation was developed which processed full-resolution stereoscopic video on the da Vinci Surgical System

    The future of robotic-assisted laparoscopic surgery

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    Introduction: Since the first revolution of robotic-assisted surgery officially happened in 2000, the healthcare service worldwide has transformed into a new era due to its superior technological advancements, particularly in laparoscopic surgery. Da Vinci which is seen as a master-slave system and Kymerax which is categorized as a hand-held device are commonly used in robotic-assisted laparoscopic surgery. Whilst a conventional or open method requires a large incision to perform a surgery, laparoscopy - a minimally invasive surgery (MIS) is an advantageous surgical method which reduces an abdominal incision to a minimum, and effectively exploited with robots. Methods: Based on available articles with the object of robotic surgical surgery, two SWOT analysis for Da Vinci and Kymerax were formulated to understand strengths, weaknesses, opportunities and threats of each system in comparison with the traditional laparoscopic surgery. From that, the future outlook is anticipated based on the scientific background. Results: Alongside technological advantages of Da Vinci mainly known as 6-degree of freedom, dexterity enhancement, stereovision, tremor filtering and especially minimal invasive surgery, it still has disadvantages that are not neglectable such as huge investment and lack of haptic feedback. Although the malfunction rate of Da Vinci is not significantly high, surgeons should be aware of it to fix or alter instruments in time. Kymerax is not as advanced as Da Vinci but it can fill in the gap of the Da Vinci which includes thelarge investment and bulky instruments. The Kymerax is the low-cost hand-held device allowing multiple degrees of freedom. It is an optimal combination between traditional performance and robotic performance allowing surgeons to manipulate in their hands and ensure haptic feedback. Conclusions: Both Da Vinci and Kymerax systems offer superior benefits for medical service due to the ongoing technological growth. The cost-effectiveness of Da Vinci system is currently a problematic issue when medical institutions consider to install them. The surgical instruments market, however, has become highly competitive which is likely leading to the decline of the costly investments. In the digital world nowadays, it will be a promising future for more integrated medical inventions

    Do Costs of Robotic Surgery Matter?

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    Robotic Surgery may Not “Make the Cut” in Pediatrics

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    Since the introduction of robotic surgery in children in 2001, it has been employed by select pediatric laparoscopic surgeons but not to the degree of adult surgical specialists. It has been suggested that the technical capabilities of the robot may be ideal for complex pediatric surgical cases that require intricate dissection. However, due to the size constraints of the robot for small pediatric patients, the tight financial margins that pediatric hospitals face, and the lack of high level data displaying patient benefit when compared to conventional laparoscopic surgery, it may be some time before the robotic surgical platform is widely embraced in pediatric surgical practice

    Robot-assisted radical prostatectomy in Hong Kong: a review of 235 cases

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    Advanced Endoscopic Navigation:Surgical Big Data,Methodology,and Applications

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    随着科学技术的飞速发展,健康与环境问题日益成为人类面临的最重大问题之一。信息科学、计算机技术、电子工程与生物医学工程等学科的综合应用交叉前沿课题,研究现代工程技术方法,探索肿瘤癌症等疾病早期诊断、治疗和康复手段。本论文综述了计算机辅助微创外科手术导航、多模态医疗大数据、方法论及其临床应用:从引入微创外科手术导航概念出发,介绍了医疗大数据的术前与术中多模态医学成像方法、阐述了先进微创外科手术导航的核心流程包括计算解剖模型、术中实时导航方案、三维可视化方法及交互式软件技术,归纳了各类微创外科手术方法的临床应用。同时,重点讨论了全球各种手术导航技术在临床应用中的优缺点,分析了目前手术导航领域内的最新技术方法。在此基础上,提出了微创外科手术方法正向数字化、个性化、精准化、诊疗一体化、机器人化以及高度智能化的发展趋势。【Abstract】Interventional endoscopy (e.g., bronchoscopy, colonoscopy, laparoscopy, cystoscopy) is a widely performed procedure that involves either diagnosis of suspicious lesions or guidance for minimally invasive surgery in a variety of organs within the body cavity. Endoscopy may also be used to guide the introduction of certain items (e.g., stents) into the body. Endoscopic navigation systems seek to integrate big data with multimodal information (e.g., computed tomography, magnetic resonance images, endoscopic video sequences, ultrasound images, external trackers) relative to the patient's anatomy, control the movement of medical endoscopes and surgical tools, and guide the surgeon's actions during endoscopic interventions. Nevertheless, it remains challenging to realize the next generation of context-aware navigated endoscopy. This review presents a broad survey of various aspects of endoscopic navigation, particularly with respect to the development of endoscopic navigation techniques. First, we investigate big data with multimodal information involved in endoscopic navigation. Next, we focus on numerous methodologies used for endoscopic navigation. We then review different endoscopic procedures in clinical applications. Finally, we discuss novel techniques and promising directions for the development of endoscopic navigation.X.L. acknowledges funding from the Fundamental Research Funds for the Central Universities. T.M.P. acknowledges funding from the Canadian Foundation for Innovation, the Canadian Institutes for Health Research, the National Sciences and Engineering Research Council of Canada, and a grant from Intuitive Surgical Inc

    The Challenge of Augmented Reality in Surgery

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    Imaging has revolutionized surgery over the last 50 years. Diagnostic imaging is a key tool for deciding to perform surgery during disease management; intraoperative imaging is one of the primary drivers for minimally invasive surgery (MIS), and postoperative imaging enables effective follow-up and patient monitoring. However, notably, there is still relatively little interchange of information or imaging modality fusion between these different clinical pathway stages. This book chapter provides a critique of existing augmented reality (AR) methods or application studies described in the literature using relevant examples. The aim is not to provide a comprehensive review, but rather to give an indication of the clinical areas in which AR has been proposed, to begin to explain the lack of clinical systems and to provide some clear guidelines to those intending pursue research in this area

    Change of practice patterns in urology with the introduction of the da Vinci surgical system: results from a Greek national hospital

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    Σκοπός: Nα καθοριστεί η αλλαγή της χειρουργικής νοοτροπίας στην Ουρολογία μετά την εισαγωγή του ρομποτικού συστήματος da Vinci (DVS). Περιγράφουμε τις σύγχρονες τάσεις σε επίπεδο δημοσίου νοσοκομείου, ενώ η χώρα βρίσκεται σε οικονομική κρίση. Υλικό και Μέθοδοι: Μελετήσαμε αναδρομικά, τα δεδομένα καταγραφής ουρολογικών χειρουργικών επεμβάσεων από το Γενικό Νοσοκομείο Αθηνών (ΓΝΑ) ‘Λαϊκό’ από το 2008 έως και το 2013. Εκτιμήσαμε τις τάσεις σχετικά με τις ρομποτικά- υποβοηθούμενες επεμβάσεις (ΡΥΕ) και την σχέση τους με την αλλαγή στο συνολικό αριθμό επεμβάσεων που πραγματοποιήθηκαν. Αποτελέσματα: Μελετήθηκαν 1578 από τις ουρολογικές επεμβάσεις που πραγματοποιήθηκαν στο ΓΝΑ ‘Λαϊκό’, από έξι χειρουργούς κατά την 6-χρονη περίοδο μελέτης, 1342 (85%) από τις οποίες έγιναν ανοικτά και 96 (15%) έγιναν ΡΥΕ. Παρατηρήσαμε αύξηση κατά έξι φορές στον αριθμό των ΡΥΕ που πραγματοποιήθηκαν, από 7 % επί του συνολικού αριθμού επεμβάσεων (14/212) το 2008 σε 30 % (96/328) το 2013, κατά κύριο λόγο από δύο χειρουργούς αφοσιωμένους στις ΡΥΕ. Όσον αφορά την ριζική προστατεκτομή, το 2008 το 2% έγινε ρομποτικά-υποβοηθούμενα και το 98% ανοικτά, ενώ το 2013 το 46% και το 54% αντιστοίχως.Οι αφοσιωμένοι χειρουργοί στις ΡΥΕ αύξησαν τον αριθμό των ΡΥΕ αλλά και το συνολικό αριθμό επεμβάσεων που πραγματοποίησαν. Από 86 επεμβάσεις το 2008 σε 145 το 2013, με το 57% από αυτές να είναι ΡΥΕ το 2013 σε σύγκριση με ποσοστό 13% το 2008. Συμπεράσματα: Η ρομποτικά-υποβοηθούμενη χειρουργική έχει ενσωματωθεί στο οπλοστάσιο του Έλληνα ουρολόγου χειρουργού σε επίπεδο δημοσίου νοσοκομείου. Η εξομοίωση με το DVS σχετίζεται επίσης με αύξηση του συνολικού αριθμού επεμβάσεων που πραγματοποιούνται, κυρίως την ριζική προστατεκτομή, παρόλη την έντονη διαμάχη περί της χρησιμότητας και της σχέσης κόστους- αποτελεσματικότητας.Purpose: To determine the attitudinal change for urologic surgery in Greece since the introduction of the da Vinci Surgical System (DVS). We describe contemporary trends at public hospital level, while at the same time Greece is in economic crisis. Materials and Methods: We retrospectively analyzed annualized case log data on urologic procedures, between 2008 (installation of the DVS) and 2013, from “Laiko’’ Hospital in Athens. We evaluated, using summary statistics, trends regarding robot- assisted surgery (RAS). Results: 1578 of the urological procedures that were performed at “Laiko’’ Hospital by six surgeons during this 6 -year period, 1342(85%) open and 236 RAS (15 %), were pooled and studied. We observed a 6-fold increase in the number of RAS performed, from 7% of the total procedural volume (14/212) in 2008 to 30% (96/331) in 2013, particularly from the two RAS –dedicated surgeons. For radical prostatectomy, in 2008 2% were robot-assisted and 98% open while in 2013, 46% and 54% respectively.RAS-dedicated surgeons increased both RAS and the total number of procedures they performed. From 86 in 2008 to 145 in 2013, with 57 % of them being RAS in 2013 as compared to 13 % in 2008. Conclusions: Robot-assisted surgery has integrated into the armamentarium for urologic surgery in Greece at national hospital level. Surgical robot acquisition is also associated with increased volume of procedures, especially prostatectomy, despite the ongoing debate over the usefulness and cost-effectiveness

    A methodology for design and appraisal of surgical robotic systems

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    Surgical robotics is a growing discipline, continuously expanding with an influx of new ideas and research. However, it is important that the development of new devices take account of past mistakes and successes. A structured approach is necessary, as with proliferation of such research, there is a danger that these lessons will be obscured, resulting in the repetition of mistakes and wasted effort and energy. There are several research paths for surgical robotics, each with different risks and opportunities and different methodologies to reach a profitable outcome. The main emphasis of this paper is on a methodology for ‘applied research’ in surgical robotics. The methodology sets out a hierarchy of criteria consisting of three tiers, with the most important being the bottom tier and the least being the top tier. It is argued that a robotic system must adhere to these criteria in order to achieve acceptability. Recent commercial systems are reviewed against these criteria, and are found to conform up to at least the bottom and intermediate tiers, the most important first two tiers, and thus gain some acceptability. However, the lack of conformity to the criteria in the top tier, and the inability to conclusively prove increased clinical benefit, is shown to be hampering their potential in gaining wide establishment
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