Review on Image Guided Surgery Systems

Nowadays modern imaging techniques can grant an excellent quality 3D images that clearly show the anatomy, vascularity, pathology and active functions of the tissues. The ability to register these preoperative images to each other, to offer a comprehensive information, and later the ability to register the image space to the patient space intraoperatively is the core for the image guided surgery systems (IGS). Other main elements of the system include the process of tracking the surgical tools intraoperatively by reflecting their positions within the 3D image model. In some occasions an intraoperative image may be acquired and registered to the preoperative images to make sure the 3D model used to guide the operation describes the actual situation at surgery time. This survey overviews the history of IGS and discusses the modern system components for a reliable application and gives information about the different applications in medical specialties that benefited from the use of IGS

Validation of the STN-DBS intervention as a treatment for Parkinson's disease by studying the accuracy of electrode placement and possible correlation with motor symptoms

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Director: Jordi Rumià Arboix. Tutor: Agustí Gutiérrez Gálvez.Parkinson’s disease is present approximately in 10 million individuals all over the world, being one of the most common neurodegenerative diseases, and statistics denote that its prevalence will raise in the coming years. Deep brain stimulation is an effective surgical treatment for patients who do not improve with drug treatment and who present many motor symptoms. Deep brain stimulation constitutes the implantation of electrodes in specific brain structures, nevertheless, this study has focused on the subthalamic nucleus, being the main target region for Parkinson’s disease. In order to have satisfactory post-surgical results, where the patient has a considerable reduction in motor symptoms, it is essential to present a correct lead placement accuracy, which corresponds with what has been planned before surgery by terms of using the neuronavigator. The principal objective of this study is to validate the accuracy of the actual technique used in the Hospital Clínic of Barcelona, which is guided exclusively by image, as well as to establish a possible relationship between the patient's clinic, following the UPDRS scale type III, once it has undergone surgery and the accuracy of the electrodes, to verify that it essential to achieve its maximum effectiveness. Thus, objective arguments of the image-guided and image-verified technique can also be given as well as providing assertion of completing the procedure with the patient completely anaesthetised, since currently in Catalonia most centres do so with the patient awake and with microelectrode recording..

Image-guided surgery and medical robotics in the cranial area

Surgery in the cranial area includes complex anatomic situations with high-risk structures and high demands for functional and aesthetic results. Conventional surgery requires that the surgeon transfers complex anatomic and surgical planning information, using spatial sense and experience. The surgical procedure depends entirely on the manual skills of the operator. The development of image-guided surgery provides new revolutionary opportunities by integrating presurgical 3D imaging and intraoperative manipulation. Augmented reality, mechatronic surgical tools, and medical robotics may continue to progress in surgical instrumentation, and ultimately, surgical care. The aim of this article is to review and discuss state-of-the-art surgical navigation and medical robotics, image-to-patient registration, aspects of accuracy, and clinical applications for surgery in the cranial area

Development and evaluation of image-guided neuroendoscopy, with investigation of post-imaging brain distortion and accuracy of frameless stereotaxy

Neuroendoscopy enables a surgeon to operate deep within the brain whilst limiting morbidity through a minimally invasive approach. Technical advances in illumination, instrumentation and camera design, along with evidence for improved clinical outcome, have increased the indications for this technique and have ensured widespread popularity. However, broader application of neuroendoscopy is restricted by the necessity for direct vision of targets and by spatial disorientation. The aim of this investigation was to overcome these limitations by combining neuronavigation with neuroendoscopy to develop Image-Guided Neuroendoscopy (IGN). The strategy adopted for this was firstly to select, assess and validate a neuronavigation system, secondly to develop methods of endoscope tracking and frameless stereotactic implantation. Thirdly, to assess the impact of post-imaging brain distortion upon neuronavigation, fourthly to correct distortion of the endoscope image and finally to assess the use of graphics overlay in IGN. Laboratory phantom accuracy assessments revealed a mean point localisation error for the navigation system pointers of0.8mm (SD 0.4mm) with CT imaging, for the tracked endoscope of 1.5mm (SD 0.8mm) and for frameless stereotaxy of 1.3mm (SD 0.6mm). An in vivo study revealed a mean Euclidean error of 4.8mm (SD 2.0mm) for frame less stereotactic biopsy. The navigation system was evaluated through a clinical series of 100 cases, the frameless stereotactic technique was employed in 21 brain biopsy procedures and IGN evaluated in 5 procedures. The magnitude of post-imaging brain distortion was determined and correlations discovered with pre-operative image characteristics. The conclusions of this thesis are that IGN can be accomplished with acceptable accuracy, including frameless stereotactic implantation, and that the impact of postimaging brain distortion will not negate the value of IGN in most cases. Thus, the method developed for IGN has overcome both major constraints of neuroendoscopy, enabling endoscopic surgery to pass through and beyond the ventricular wall, to be undertaken safely in cases with distorted anatomy and opening the potential for wider application of these minimally invasive techniques

Determination and quantitative evaluation of image-based registration accuracy for robotic neurosurgery

Stereotactic neurosurgical robots allow quick, accurate location of small targets within the brain, relying on accurate registration of preoperative MRI/CT images with patient and robot coordinate systems. Fiducial markers or a stereotactic frame are used as registration landmarks and the patient’s head is fixed in position. An image-based system could be quick, non-invasive and allow the head to be moved during surgery giving greater ease of access. Submillimetre surgical precision at the target point is required. An octant representation is utilized to investigate full region of interest (ROI) head registration using parts only, with registration performed using the Iterative Closest Point (ICP) algorithm. Use of two octants sequentially obtained a mean RMS distance of 0.813±0.026 mm; adding subsequent octants did not significantly improve performance. An RMS distance of 0.812±0.025 mm was obtained for three octants used simultaneously. ICP was compared with Coherent Point Drift, and 3D Normal Distribution Transform, with and without added or smoothed noise, and was least affected by starting position or noise added; a mean accuracy of 0.884±0.050 mm across ten noise levels and four starting positions was achieved, which was shown to translate to submillimetre accuracy at points within the head

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not