We present a new framework for in vivo image guidance evaluation and provide a case study on robotic partial nephrectomy. Methods: This framework (called the "bystander protocol") involves two surgeons, one who solely performs the therapeutic process without image guidance, and another who solely periodically collects data to evaluate image guidance. This isolates the evaluation from the therapy, so that in-development image guidance systems can be tested without risk of negatively impacting the standard of care. We provide a case study applying this protocol in clinical cases during robotic partial nephrectomy surgery. Results: The bystander protocol was performed successfully in 6 patient cases. We find average lesion centroid localization error with our IGS system to be 6.5 mm in vivo compared to our prior result of 3.0 mm in phantoms. Conclusions: The bystander protocol is a safe, effective method for testing in-development image guidance systems in human subjects.
Using an image guidance system constructed over the past several years [1], [2] we have recently collected our first in vivo human pilot study data on the use of the da Vinci for image guided partial nephrectomy [3]. Others have also previously created da Vinci image guidance systems (IGS) for various organs, using a variety of approaches [4]. Our system uses touch-based registration, in which the da Vinci’s tool tips lightly trace over the tissue surface and collect a point cloud. This point cloud is then registered to segmented medical images. We provide the surgeon a picture-in-picture 3D Slicer display, in which animated da Vinci tools move exactly as the real tools do in the endoscope view (see [2] for illustrations of this). The purpose of this paper is to discuss recent in vivo experiences and how they are informing future research on robotic IGS systems, particularly the use of ultrasound.
Many otologic surgeries, including cochlear implantation and mastoidectomy, require a post-auricular incision for exposure. The auricle must be retracted forward in order to enable an unobstructed view of the surgical field and improve procedural outcomes. Typical methods of securing the ear include tape, a small stitch, or an assistant’s finger, depending on surgeon preference. In this paper, we propose a novel design for a tool that retracts the auricle safely, effectively, and consistently with the appropriate tension for closure of a post-auricular incision. The tool attaches to the helix with a compression fit, and then anchors between the triangular fossa and the helical crus. The tool’s efficacy is demonstrated through a test fit and comparison to standard methods. This anchoring tool enables the surgeon to retract the pinna easily and effectively.
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