Image overlay navigation by markerless surface registration in gastrointestinal, hepatobiliary and pancreatic surgery

Journal of Hepato-Biliary-Pancreatic Sciences - Tập 17 Số 5 - Trang 629-636 - 2010
Maki Sugimoto1,2, Hideki Yasuda2, Keiji Koda2, Masato Suzuki2, Masato Yamazaki2, Tohru Tezuka2, Chihiro Kosugi2, Ryota Higuchi2, Yoshihisa Watayo2, Yohsuke Yagawa2, Shuichiro Uemura2, Hironori Tsuchiya2, Takeshi Azuma1
1Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 Japan
2Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111 Japan

Tóm tắt

AbstractBackgroundWe applied a new concept of “image overlay surgery” consisting of the integration of virtual reality (VR) and augmented reality (AR) technology, in which dynamic 3D images were superimposed on the patient's actual body surface and evaluated as a reference for surgical navigation in gastrointestinal, hepatobiliary and pancreatic surgery.MethodsWe carried out seven surgeries, including three cholecystectomies, two gastrectomies and two colectomies. A Macintosh and a DICOM workstation OsiriX were used in the operating room for image analysis. Raw data of the preoperative patient information obtained via MDCT were reconstructed to volume rendering and projected onto the patient's body surface during the surgeries. For accurate registration, OsiriX was first set to reproduce the patient body surface, and the positional coordinates of the umbilicus, left and right nipples, and the inguinal region were fixed as physiological markers on the body surface to reduce the positional error.ResultsThe registration process was non‐invasive and markerlesss, and was completed within 5 min. Image overlay navigation was helpful for 3D anatomical understanding of the surgical target in the gastrointestinal, hepatobiliary and pancreatic anatomies. The surgeon was able to minimize movement of the gaze and could utilize the image assistance without interfering with the forceps operation, reducing the gap from the VR. Unexpected organ injury could be avoided in all procedures. In biliary surgery, the projected virtual cholangiogram on the abdominal wall could advance safely with identification of the bile duct. For early gastric and colorectal cancer, the small tumors and blood vessels, which usually could not be found on the gastric serosa by laparoscopic view, were simultaneously detected on the body surface by carbon dioxide‐enhanced MDCT. This provided accurate reconstructions of the tumor and involved lymph node, directly linked with optimization of the surgical procedures.ConclusionsOur non‐invasive markerless registration using physiological markers on the body surface reduced logistical efforts. The image overlay technique is a useful tool when highlighting hidden structures, giving more information.

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Journal of Hepato-Biliary-Pancreatic Sciences

Tập 17 Số 5

629-636

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