Improving vision for surgeons during laparoscopy: the Enhanced Laparoscopic Vision System (ELViS)

Abstract

Background: For many abdominal surgical interventions, laparotomy has gradually been replaced by laparoscopy, with numerous benefits for the patient in terms of post-operative recovery. However, during laparoscopy, the endoscope only provides a single viewpoint to the surgeon, leaving numerous blind-spots and opening the way to peri-operative adverse events. Alternative camera systems have been proposed, but many lack the requisite resolution/robustness for use during surgery or cannot provide real-time images. Here, we present the added value of the Enhanced Laparoscopic Vision System (ELViS) which overcomes these limitations and provides a broad view of the surgical field in addition to the usual high-resolution endoscope.Methods: Experienced laparoscopy surgeons performed several typical procedure steps on a live pig model. The time-to-completion for surgical exercises performed by conventional endoscopy and ELViSassisted surgery was measured. A debriefing interview following each operating session was conducted by an ergonomist, and a System Usability Scale (SUS) score was determined.Results: Proof of concept of ELVIS was achieved in an animal model with 7 expert surgeons without peroperative adverse events related to the surgical device. No differences were found in time-tocompletion. Mean SUS score was 74.7, classifying the usability of the ELViS as "good". During the debriefing interview, surgeons highlighted several situations where the ELViS provided a real advantage (such as during instrument insertion, exploration of the abdominal cavity or for orientation during close work), and also suggested avenues for improvement of the system.Conclusions: This first test of the ELViS prototype on a live animal model demonstrated its usability and provided promising and useful feedback for further development.

Qualitative Comparison of Image Stitching Algorithms for Multi-Camera Systems in Laparoscopy

“…While we took care to develop a realistic environment, we cannot provide a quantitative metric proving its degree of realism. However, compared to the environments used by researchers who evaluate multi-camera prototypes (ex-vivo organs, meat or plastic-like organs [ 6 , 9 , 10 ]), we believe that we were able to progress one step further in terms of realism. Moreover, this environment can be well integrated in the iterative prototyping process.…”

“… Global homography , used on prototype [ 6 ], was not designed to solve parallax problems since it assumes elements of the scene are coplanar or very far from the cameras (as with mountains in a panoramic photography), which is not true in scenes with very close elements, such as forceps. Thus, this algorithm is not sufficient for use in laparoscopy.…”

“…As shown on Figure 1 , it contains: Organs, with corresponding realistic image textures, e.g., intestines, blood vessels, abdomen; Tools: laparoscopic forceps and a 5 mm endoscope with LEDs; Multi-camera prototypes, where the number of cameras and their focals, FoVs and inter-spaces can be modified. In this study, we simulated the multi-camera prototype of [ 6 ] with two deployable Misumi TD-VBL31105L-77 cameras (1.83 mm focal, 69° × 43° FoV) and an inter-space of 4.5 cm. These specifications were established according to the results of a specifically performed experiment, provided in Supplementary Material Figures S4 and S5 , which showed that this was a good compromise between overlap and the enlargement of the field of view.…”

“…A recent approach developed to increase the FoV relies on the use of multi-camera systems, in which multiple miniature cameras are used conjointly to increase the single endoscope’s FoV. In [ 6 ], a modified trocar with two miniature cameras was evaluated through animal experiments. Preliminary works have shown a reduction in operating time, in the number of commands of a robotic endoscope holder [ 7 ], and a faster reaction to adverse events [ 8 ] in a testbench environment.…”

“…In [ 10 ], a push-button was used to increase the space between two endoscopic cameras to widen the FoV. Most of these systems provide multiple video streams from the different cameras, but displaying these streams on multiple screens, as in prototype [ 6 ], is not optimal. It induces an increased mental workload for the surgeon, who needs to quickly apprehend how the scenes relate to each other.…”