We developed a simple, light, and cheap 3-D visualization device based on mixed reality that can be used by physicians to see preoperative radiological exams in a natural way. The system allows the user to see stereoscopic "augmented images," which are created by mixing 3-D virtual models of anatomies obtained by processing preoperative volumetric radiological images (computed tomography or MRI) with real patient live images, grabbed by means of cameras. The interface of the system consists of a head-mounted display equipped with two high-definition cameras. Cameras are mounted in correspondence of the user's eyes and allow one to grab live images of the patient with the same point of view of the user. The system does not use any external tracker to detect movements of the user or the patient. The movements of the user's head and the alignment of virtual patient with the real one are done using machine vision methods applied on pairs of live images. Experimental results, concerning frame rate and alignment precision between virtual and real patient, demonstrate that machine vision methods used for localization are appropriate for the specific application and that systems based on stereoscopic mixed reality are feasible and can be proficiently adopted in clinical practice.

We have successfully developed a system for computer-assisted technologies for use in laparoscopic surgery and demonstrated, by early clinical trials, that the introduction of these technologies in operative laparoscopy, even though they are not yet sufficiently accurate (from an engineering viewpoint) for surgical treatment of intra-abdominal disease, brings added benefits to the execution of interventions by surgeons and hence represents concrete on-going progress in interventional technology.

Ultrasound-guided biopsy is a proficient mininvasive approach for tumors staging but requires very long training and particular manual and 3D space perception abilities of the physician, for the planning of the needle trajectory and the execution of the procedure. In order to simplify this difficult task, we have developed an integrated system that provides the clinician two types of assistance: an augmented reality visualization allows accurate and easy planning of needle trajectory and target reaching verification; a robot arm with a six-degree-of-freedom force sensor allows the precise positioning of the needle holder and allows the clinician to adjust the planned trajectory (cooperative control) to overcome needle deflection and target motion. Preliminary tests have been executed on an ultrasound phantom showing high precision of the system in static conditions and the utility and usability of the cooperative control in simulated no-rigid conditions.

The model provides data on the evaluation of biomechanical parameters of surgical gesture not only in kinematic terms but also includes analysis of the dynamics of muscle contraction analysis during surgical manipulations.

BACKGROUND:The STAR System (Ekymed SpA) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery.MATERIALS AND METHODS:Between December 2012 and December 2014, we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve haemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of haemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups.RESULTS:The principal RI was haemostasis for minor bleeding, without differences between the two groups (P = not significant). Regard to MU, in the robotic group cleaning the surgical field was utilised more than laparoscopic group (100% vs. 60%; P = 0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% vs. 0%; P = 0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% vs. 80%; P = 0.03).CONCLUSIONS:The STAR System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/mopping the operative field when necessary, who may not be experienced or completely proficient.