Live augmented reality: A new visualization method for laparoscopic surgery using continuous volumetric computed tomography

Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
Surgical Endoscopy (Impact Factor: 3.26). 02/2010; 24(8):1976-85. DOI: 10.1007/s00464-010-0890-8
Source: PubMed


Current laparoscopic images are rich in surface detail but lack information on deeper structures. This report presents a novel method for highlighting these structures during laparoscopic surgery using continuous multislice computed tomography (CT). This has resulted in a more accurate augmented reality (AR) approach, termed "live AR," which merges three-dimensional (3D) anatomy from live low-dose intraoperative CT with live images from the laparoscope.
A series of procedures with swine was conducted in a CT room with a fully equipped laparoscopic surgical suite. A 64-slice CT scanner was used to image the surgical field approximately once per second. The procedures began with a contrast-enhanced, diagnostic-quality CT scan (initial CT) of the liver followed by continuous intraoperative CT and laparoscopic imaging with an optically tracked laparoscope. Intraoperative anatomic changes included user-applied deformations and those from breathing. Through deformable image registration, an intermediate image processing step, the initial CT was warped to align spatially with the low-dose intraoperative CT scans. The registered initial CT then was rendered and merged with laparoscopic images to create live AR.
Superior compensation for soft tissue deformations using the described method led to more accurate spatial registration between laparoscopic and rendered CT images with live AR than with conventional AR. Moreover, substitution of low-dose CT with registered initial CT helped with continuous visualization of the vasculature and offered the potential of at least an eightfold reduction in intraoperative X-ray dose.
The authors proposed and developed live AR, a new surgical visualization approach that merges rich surface detail from a laparoscope with instantaneous 3D anatomy from continuous CT scanning of the surgical field. Through innovative use of deformable image registration, they also demonstrated the feasibility of continuous visualization of the vasculature and considerable X-ray dose reduction. This study provides motivation for further investigation and development of live AR.

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    • "In endoscopic and laparoscopic surgery, a telescopic rod lens with a video camera is used to guide surgical instruments to the patient anatomy through small incisions or keyholes. Laparoscopic systems were specified for liver [58], digestive [22], abdominal [70], prostate [67], urologic [74] and robotic surgery [73] or simply general laparoscopic surgery [79] [78] [7] [59]. Endoscopic robotic systems were described by Suzuki et al. [73] and Sudra et al. [16]. "
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    ABSTRACT: Current generation minimally invasive surgeries present many visualization challenges, including two-dimensional representation of three-dimensional anatomy and a lack of visualization of deeply recessed structures. Coupled with the loss of tactile feedback which places greater emphasis on available visual cues, improved surgical visualization remains a long-standing need. Our response to address this need is Live Augmented Reality (Live AR), in which processed images from live radiologie scans of the surgical field are merged with optical images, accounting for spatial and temporal registration. We have demonstrated the feasibility of Live AR, but its clinical implementation is hampered by many current technical limitations. Ln this report, we have presented guidance of a simple laparoscopic maneuver completely based on computed tomography (CT) scanning and rapid 3D rendering of the acquired images in the CT room. The capability developed here and the reported results constitute a step toward the eventual goal of routine clinical implementation of Live AR.
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