Image-guided real-time navigation for transanal total mesorectal excision: a pilot study

Atallah, S.; Martin‐Perez, B.; Larach, Sergio W.

doi:10.1007/s10151-015-1329-y

Cited by 47 publications

(34 citation statements)

References 16 publications

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“…The ''augmented eye'' and ''augmented hand'' to improve precision in NOTES TME Atallah et al [30,31] were the first colorectal surgeons who felt the urge to apply a real-time stereotactic navigation system, mainly to prevent ureteral injuries, to this new anatomy of transanal TME. In line with previous and validated applications of stereotactic navigation in neurosurgery [32] and maxillofacial surgery [33], authors proposed to use a standard stereotaxic system, made up of near-infrared stereoscopic cameras capable of tracking reference markers placed on the patient's skin and on working instruments.…”

Section: Introductionmentioning

confidence: 99%

The quest for precision in transanal total mesorectal excision

2015

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Transanal total mesorectal excision (TME) is an emerging minimally invasive approach to rectal cancer, with encouraging preliminary results. However, the new surgical anatomy of the bottom-up approach complicates surgical understanding and increases the risks of inadvertent injuries to crucial anatomical structures, including nerves. Key elements to improve the safety and stimulate interest in such a complex technique might be robotics and image guidance, to enhance the level of precision. In this editorial, some of the technologies that could be used for precision TME are outlined, in light of the experience of our Institute for Image-Guided Surgery.

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Section: Introductionmentioning

confidence: 99%

The quest for precision in transanal total mesorectal excision

2015

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“…Stereotactic navigation for surgery utilizes computed tomography (CT) or magnetic resonance imaging (MRI) images that are rendered in a multiplanar format such that the data points can be interpreted by the navigation software [6]. Using infrared trackers and a ceiling mounted infrared camera, 3D data from body imaging can be used in real time to perform 'digital surgery' [4].…”

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confidence: 99%

“…The use of augmented reality for improved surgical precision [2] has recently been applied to pelvic surgery [3], and the use of these approaches could help improve resection quality as digital information from various source data can aid surgeons by providing real-time, usable and relevant data [4][5][6].Stereotactic navigation for surgery utilizes computed tomography (CT) or magnetic resonance imaging (MRI) images that are rendered in a multiplanar format such that the data points can be interpreted by the navigation software [6]. Using infrared trackers and a ceiling mounted infrared camera, 3D data from body imaging can be used in real time to perform 'digital surgery' [4].…”

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Real-time stereotactic navigation for the laparoscopic excision of a pelvic neoplasm

Atallah¹,

Tilahun

Monson

2016

Tech Coloproctol

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Navigation for surgery is an important tool that can provide surgeons with enhanced information when operating on fixed anatomic targets [1]. The use of augmented reality for improved surgical precision [2] has recently been applied to pelvic surgery [3], and the use of these approaches could help improve resection quality as digital information from various source data can aid surgeons by providing real-time, usable and relevant data [4][5][6].Stereotactic navigation for surgery utilizes computed tomography (CT) or magnetic resonance imaging (MRI) images that are rendered in a multiplanar format such that the data points can be interpreted by the navigation software [6]. Using infrared trackers and a ceiling mounted infrared camera, 3D data from body imaging can be used in real time to perform 'digital surgery' [4].In this video, the technique of real-time navigation is applied to the laparoscopic excision of a pelvic neoplasm. The video emphasizes how the operating surgeon is able to interpret and utilize stereotactic navigation during surgery to localize and then excise a pelvic neoplasm in the deep perirectal space.In this clinical example, a 79-year-old female presented with chronic pelvic pain. Workup included physical examination-including anoscopy, proctoscopy and colonoscopy which were all unremarkable. However, a pelvic MRI demonstrated a complex, mixed cystic and solid neoplasm in the left perirectal space measuring 2 9 2.3 9 2.9 cm in dimension with an ill-defined solid, internal component measuring 1.1 cm. Malignancy could not be excluded by radiographic criterion. Surgical intervention using a minimally invasive, laparoscopic technique was utilized to perform a complete excision of the neoplasm, which was removed intact. The navigation accuracy (mean deviation) measured ±1.8 mm. Operative time was 124 min which included 38 min of navigation setup time. The setup time included time for intra-operative CT scan with placement of skin fixed fiducials, navigation software and instrument calibration.The patient was discharged on the first postoperative day. There was no perioperative morbidity. At 10-week follow-up, the patient reported complete resolution of her pelvic pain. Finally, pathology revealed a 50 % solid and 50 % cystic neoplasm measuring 3.0 9 2.0 9 1.5 cm and was consistent with a serous cyst adenofibroma of the ovary with an atypical placement beneath the peritoneal reflection.The video forum provides a description of the operation as seen from the surgeon's point of view to help viewers understand how augmented reality can aid in the localization of fixed anatomic targets with precision.

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“…This is analogous to (using the aviation paradigm) a ground-proximity warning system designed to alert pilots of approaching terrain. Other applications include (b) the use of intra-operative ultrasound imaging to localize anatomic targets (such as with liver metastasectomy); (c) fluorescent angiography to quantify tissue perfusion [4]; and (d) PACS images overlayed with navigational markers to determine the 3D position in space of a surgeon's instrument so that correct anatomic planes are realized and maintained during complex surgery-such has been demonstrated with transanal total mesorectal excision [5,6] (Fig. 1a, b).…”

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The dawn of the digital operating theatre and the rise of the digital surgeon

Atallah¹

2015

Tech Coloproctol

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Let us begin by asking this seemingly simple question: What is minimally invasive surgery? While minimally invasive surgery (MIS) is typically defined as using smaller incisions to accomplish the same operative task as conventional surgery, it must also be appreciated that this methodology has been an important step towards the creation of the digital operating theatre. Why?Fundamentally, both laparoscopic and robotic MIS rely on a digitized video image sequences from a charge-coupled device (CCD) camera, which are then converted into digital signals and relayed at near-instant speed-approximately 0.7 times the speed of light. These signals are then typically processed and then projected onto a liquid crystal display (LCD) high-definition monitor. In the simplest sense, an MIS surgeon performs digital surgery, because the operation is carried out based on the surgeon's interpretation of the real-time digitized cine displayed on LCD rather than direct visualization of the patient's anatomy.This concept, essential to all forms of MIS, represents an important departure from conventional surgery, and a crucial segue towards the realm of true digital surgery. Thus, an MIS surgeon operates not by looking at a patient but rather by looking at digitized information that represents the patient-a sequential stream of 1 and 0 s converted into 'picture elements' (aka, pixels) via LCD and the image rendered visible by red-green-blue colour modelling. With robotic master-slave platforms, the surgeon is removed from the patient altogether. Nevertheless, despite the absence of haptic feedback, very precise surgical dissection is possible with robotic MIS and the prospect of telemedicine becomes real-because of the ability to convert human anatomy into digital data points that can be streamed to a remote site in real time.In the field of surgery, parallels are often drawn to the aviation industry due to the rigorous, safety-oriented protocols it mandates [1]. But another important aviation paradigm relates to navigation and includes the digitization of information and the processes used for data interpretation via advanced avionics. For instance, a pilot utilizes sophisticated navigational aides and fly-by-wire technology that allow an aircraft to travel safely in precise flight paths and at high velocity without reliance on visual references. In essence, a pilot can determine craft position and trajectory by using digital navigation inputs from various computer-centric instruments including the geostationary satellite global positioning system. For more complex vehicle navigation, system informatics and computing centres are necessary-such as those utilized for the manned space flight programme. The reason such systems are employed is because they are accurate and reliable and because a digital-based, augmented reality provides more meaningful information than visual cues alone. So then, if a pilot is able to navigate an aircraft by relying on digital information only, can a surgeon navigate though surgical planes in the same f...

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Image-guided real-time navigation for transanal total mesorectal excision: a pilot study

Cited by 47 publications

References 16 publications

The quest for precision in transanal total mesorectal excision

The quest for precision in transanal total mesorectal excision

Real-time stereotactic navigation for the laparoscopic excision of a pelvic neoplasm

The dawn of the digital operating theatre and the rise of the digital surgeon

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