A Multimodality Navigation System for Endoscopic Fetal Surgery: A Phantom Case Study for Congenital Diaphragmatic Hernia

Abstract

This paper aims to present and evaluate a robotic-assisted Multimodality Navigation system for use in Endoscopic Fetal Surgery. Fetal surgery is an emerging field of minimally invasive surgery, which uses ultrasound guidance, where the entire procedure is done within a constrained anatomical volume and suffers from the difficulties of limited working space. Fetal surgeries require extensive experience in coordination of hand-eye-ultrasound-surgical equipment, knowledge and precise assessment of relative anatomy. As a result, such surgeries require skills that can only be acquired over long periods of training. While there are navigation systems available for similar constrained working spaces in arthroscopic and cardiovascular procedures, fetal minimally invasive surgery does not yet have a dedicated navigation platform capable of supporting robotic instruments which can be adapted to the set of unique procedures. This paper discusses the testing of the said novel multimodality navigation system in a phantom environment developed for this purpose. The outcomes suggest that the subjects demonstrated an increase in average reaching accuracy by about 60% and an overall reduction in time taken by 33.6%. They also, showed higher levels of confidence in reaching the targets, which was visualized from the pattern of trajectory of movements during the procedure. Background Methods This paper presents a Multi-modality tracking and navigation system achieved by merging optical tracking and ultrasound imaging into a novel navigation software to help the surgical pre-planning and real-time target setting and guidance. To evaluate the navigation system, a phantom surgical environment was found necessary.