Navigation in Endoscopic Soft Tissue Surgery: Perspectives and Limitations

Abstract

Abstract-Despite rapid developments in the research areas medical imaging, medical image processing and robotics, the use of computer assistance in surgical routine is still limited to diagnostics, surgical planning, and interventions on mostly rigid structures. In order to establish a computer aided workflow from diagnosis to surgical treatment and follow-up, several proposals for computer assisted soft tissue interventions have been made in recent years. By means of different pre-and intraoperative information sources, like surgical plannings, intraoperative imaging, and tracking devices, surgical navigation systems aim at supporting surgeons in localizing anatomical targets, observing critical structures, and sparing healthy tissue. Current research in particular addresses the problem of organ shift and tissue deformation, and obstacles in communication between navigation system and surgeon.In this article, we review computer assisted navigation systems for soft tissue surgery. We concentrate on approaches which can be applied in endoscopic thoracic and abdominal surgery, as endoscopic surgery has special needs for image guidance due to limitations in perception. Furthermore, this article provides the reader with new trends and technologies in the area of computer assisted surgery. Finally, a balancing of key challenges and possible benefits of endoscopic navigation refines the perspectives of this increasingly important discipline of computer aided medical procedures.

Optical techniques for 3D surface reconstruction in computer-assisted laparoscopic surgery

“…The most challenging scenarios for obtaining reference data are cadaver, in vivo and wet lab experiments, which are mostly presented to qualitatively demonstrate practical feasibility (Richa et al, 2008a,b;Noonan et al, 2009;Stoyanov et al, 2010). Quantitative in vivo validation of techniques could be performed by calibrating the endoscope with an intra-operative CT as also shown in (Feuerstein et al, 2008) and acquiring the images under breath-hold.…”

“…(Marescaux et al, 2004;Mutter et al, 2010;Nozaki et al, 2012;Pratt et al, 2012)) proposed manual alignment of pre-operatively and intra-operatively acquired images. The majority of (semi-) automatic approaches for registering the endoscopic image data with 3D anatomical data acquired pre-or intra-operatively are either marker-based (Baumhauer et al, 2008;Falk et al, 2005;Ieiri et al, 2011;Marvik et al, 2004;Megali et al, 2008;Mourgues et al, 2003;Simpfendorfer et al, 2011;Suzuki et al, 2008) or use external tracking devices that are initially calibrated with respect to the imaging modality (Ukimura and Gill, 2008;Konishi et al, 2007;Shekhar et al, 2010;Feuerstein et al, 2008;Konishi et al, 2007;Feuerstein et al, 2007;Leven et al, 2005;Blackall et al, 2000)). In an alternative approach, reconstructed surface data may be used to perform the registration with pre-operative models (Audette et al, 2000).…”

“…Recent reviews have discussed the role of computer vision in MIS Mirota et al, 2011;Stoyanov et al, 2012) and for surgical navigation (Baumhauer et al, 2008;Nicolau et al, 2011;Cleary and Peters, 2010). With this paper, which evolved from a tutorial on 3D surface reconstruction organized at the 14th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI) 2011, we address a technical audience that is already familiar with the fundamental concepts in surgical navigation and computer vision.…”

Laparoscopic video analysis for training and image-guided surgery

“…It has to be noted that a segmentation of structures is mostly limited to those which are clearly discernible in the image by the algorithm, as e.g. vessels by use of a contrast agent (8). The segmentation algorithm used for laparoscopic images has to be able to detect any region that has a slightly different colour compared to its neighbouring regions, because small differences in colour or texture may indicate different or special regions that should be taken into account when performing a surgical technique.…”

“…Image-guided surgery (IGS) systems have the potential to compensate these limitations. However, difficulties arise in the case of soft-tissue surgeries, such as those of the abdominal cavities, where there are technical challenges to cope with such as tissue deformation, shifting and other topological changes caused by the pneumoperitoneum, respiration, heart rate or tissue manipulation (8). Thus, organ tracking presents even greater difficulties due to said phenomena, and the use of fiducial markers and optical or electromagnetic systems to track organ deformations is not a feasible solution in many cases.…”