Real-time computed tomography-based augmented reality for natural orifice transluminal endoscopic surgery navigation

Abstract

Background Natural orifice transluminal endoscopic surgery (NOTES) is technically challenging owing to endoscopic short-sighted visualization, excessive scope flexibility and lack of adequate instrumentation. Augmented reality may overcome these difficulties. This study tested whether an image registration system for NOTES procedures (IR-NOTES) can facilitate navigation. Methods In three human cadavers 15 intra-abdominal organs were targeted endoscopically with and without IR-NOTES via both transgastric and transcolonic routes, by three endoscopists with different levels of expertise. Ease of navigation was evaluated objectively by kinematic analysis, and navigation complexity was determined by creating an organ access complexity score based on the same data. Results Without IR-NOTES, 21 (11·7 per cent) of 180 targets were not reached (expert endoscopist 3, advanced 7, intermediate 11), compared with one (1 per cent) of 90 with IR-NOTES (intermediate endoscopist) (P = 0·002). Endoscope movements were significantly less complex in eight of the 15 listed organs when using IR-NOTES. The most complex areas to access were the pelvis and left upper quadrant, independently of the access route. The most difficult organs to access were the spleen (5 failed attempts; 3 of 7 kinematic variables significantly improved) and rectum (4 failed attempts; 5 of 7 kinematic variables significantly improved). The time needed to access the rectum through a transgastric approach was 206·3 s without and 54·9 s with IR-NOTES (P = 0·027). Conclusion The IR-NOTES system enhanced both navigation efficacy and ease of intra-abdominal NOTES exploration for operators of all levels. The system rendered some organs accessible to non-expert operators, thereby reducing one impediment to NOTES procedures.

Multi-atlas pancreas segmentation: Atlas selection based on vessel structure

“…Automated abdominal organ segmentation from three-dimensional medical images is one of the essential components for clinical applications, such as computeraided diagnosis (CAD) (Kobatake (2007)), computerassisted surgery (CAS) planning and navigation (Azagury et al (2012)). Pancreatic cancer has recently been increasing globally (Ito et al (2013)), and its mortality rate is the fourth among cancer-related deaths in Japan, 2011 (Matsuda et al (2011)).…”

Natural orifice transluminal endoscopic surgery (NOTES) for clinical management of intra‐abdominal diseases

“…Three‐dimensional (3D) images might enhance the appreciation of depth for more accurate navigation during NOTES. This could be a feature integrated into the design of a novel multi‐tasking platform . Holler et al .…”

Endoscopic navigation system with extended field of view using augmented reality technology

“…The benefits of the developed system are easily transferable to other endoscopic surgical applications, such as endoscopic sinus/cardiac/liver surgery and natural orifice transluminal endoscopic surgery (NOTES) . For abdominal applications, the soft‐tissue deformation needs to be considered due to insufflation of gas inside the abdomen .…”